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Underage Drinking and Teen Alcohol Abuse Opinion Essay

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In the findings of the NationalCenteronAddictionandSubstanceAbuse,the statistics reveals that almost80%ofhighschoolstudentshave tasted alcohol (“Should the drinking age be lowered from 21 to a younger age?” 1).

Despite the legal drinking age in America being at twenty-one years of age, a substantial number of us may have direct experience of alcohol consumption. Often, some teenagers believe that drinking alcohol helps them to facilitate solutions to their problems. Besides, they think of alcohol a reachable escape route from the numerous pressures and expectations from family members.

As a matter of fact, alcohol does not only affect ourselves but also the people around us. For instance, many victims of drunk-driving die in grisly road accidents and leave their families dejected and orphaned. Moreover, sometimes it is the bread winner who perishes in these avoidable accidents.

Reflectively, I believe most of the teenagers know alcohol as a harmful chemical with lifelong effects on its consumer. If this knowledge is put into practice, the outcome can greatly impact their health (“Risky Business: The Gamble” 1). Then why should we drink?

Across the states of America, teenagers generally start driving at the age of sixteen, as compared to teens in other continents such as Europe who begin driving at the age of 18.The positive index of age in Europe substantially ensures greater safety for the driver in terms of maturity and responsibility. However, due to low legal driving age in America, many teenagers are prone to the risk of driving under the influence of alcohol than in other countries.

In a study carried out in 2008, the results reveal that over 1.4 million drivers were arrested for driving under the influence of alcohol (“The Nemours Foundation” 1). In addition, drugs such as marijuana and cocaine contributed to about 18% of motor vehicle driver deaths (“Should the drinking age” 2). These drugs are often used in combination with alcohol. Alcohol opens the gate to drug abuse. Once you are addicted to alcohol, drugs might come along as well.

Social pressures are another cause of alcohol abuse among high school students. Due to the peer pressure, teenagers do things that they do not want to match up with the status quo. Afraid of rejection and wanting to appear mature for their age, teens participate in alcohol consumption to look “cool”.

Unfortunately, these teens end up wasted in the quest for an identity and uncontrolled freedom in pretence of having fun. While the image of drinking may appear cool to some people, getting drunk influences a person to do extremely un-cool things (“High-Risk Drinking in College: What We Know and What We Need to Learn” 1). Also, teenagers who are afraid of being rejected by friends drink in order to maintain the friendship between them.

Alcohol slows the functioning of central nervous system and blocks some of the messages to the brain. These effects are beyond our imagination as the whole biological organs are slowed down with the labor of digesting the toxic chemical in alcohol. The physical effects of alcohol consumption includes difficulty walking, blurred vision, slurred speech, slowed reaction times, and impaired memory.

According to National institute on alcohol abuse and alcoholism alcohol damages the brain, cause blackouts, memory lost, and liver disease (“Alcohol-Induced Liver Disease” 1). Although consuming alcohol may trigger the feeling of joy and relieved stress, the hangovers in the morning is not very lovely and you realize the problems are still there (“Alcohol-Induced Liver Disease” 1).

Drinking is not the right way to escape from reality. The temporarily feeling will of relief never solves the troubles in your life. Alcohol is a depressant when consumed in large quantities and can cause alcohol poisoning which leads to difficulty in breathing, seizures or even death.

Besides, consumption beyond the liver’s ability to process may result in imbalance and injure the liver. Consequently, liver disease may cause persistent bleeding from veins in the esophagus, high blood pressure in the liver, coma, and liver cancer(“Why should I say no to alcohol?.” 3).

The harmful effects of alcohol surpass its benefits. Thus, lower drinking age may be fatal in long run due to brain damage. When high school students start drinking at an earlier age, it will have effects on brain developing, physical, and mental health. Since teens who take alcohol have a higher chance of academic failure, allowing them to access alcohol negates their academic performance (“Risky Business: The Gamble” 1).

As a result of tender drinking age, the brain cannot fully develop making them to be prone to academic failure. The most practical solution to underage drinking is parental involvement in the emotional life of their children. Besides, the government should reinforce law agencies which monitor accessibility of harmful drugs on under age. I addition, hefty fines should be posted on the stores which sell alcohol to under age.

In conclusion, alcohol remains to be a challenge in the relationship among parents and their teenage children. Drinking comes with many responsibilities and if abused, may ultimately lead to long-term consequences. Alcohol does not only affect ourselves but also people around us.

Works Cited

“Alcohol-Induced Liver Disease.” American Liver Foundation, September 28th, 2007. Web.

“High-Risk Drinking in College: What We Know and What We Need To Learn.” N.p., 9/23/2005. Web.

“Risky Business: The Gamble.” Alcohol Awarness . The University of Lethbridge, January 11,2005. Web15,0CT, 2011.

“Should the drinking age be lowered from 21 to a younger age?.” ProCon.org . N.p., 5/24/2010. Web15,0CT, 2011

“The Nemours Foundation.” Alcohol . N.p., April 2009. Web15,0CT, 2011

“Why should I say no to alcohol?.” Drinking: Facts for Teens . N.p., 11/09. Web15,0CT, 2011

Drug Trafficking and Drug Abuse
Boyz N the Hood (R language, sex, violence)
Effects of Alcohol. Alcohol-Related Statistics
Alcohol: Should the US Lower the Drinking Age to 18?
The Debate About Lowering the Drinking Age
On the Issue of Drunk Driving
The Connection Between Drugs and Crime
The Greater Good
The Value of Cultural Diversity in Different Social Settings
Mobile Phones Use in the Learning Institutions
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Chicago (N-B)

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Reducing Underage Drinking: A Collective Responsibility (2004)

Chapter: 1. introduction: the challenge, 1 introduction: the challenge.

A lcohol use by children, adolescents, and young adults under the legal drinking age of 21 produces human tragedies with alarming regularity. Motor vehicle crashes, homicides, suicides, and other unintentional injuries are the four leading causes of death of 15- to 20-year-olds, and alcohol is a factor in many of these deaths. Indeed, so many underage drinkers die in car crashes that this problem, by itself, is a major national concern. In relation to the number of licensed drivers, young people under age 21 who have been drinking are involved in fatal crashes at twice the rate of adult drivers (National Highway Traffic Safety Administration, 2002a).

Car crashes are the most visible and most numbing consequences of underage drinking, but they represent only a small proportion of the social toll that underage drinking takes on the present and future welfare of society. Other damaging problems include dangerous sexual practices that lead to both serious disease and unwanted pregnancies, unintentional injuries, fights, and school failures that lead to expulsions or withdrawals. Levy et al. (1999) estimated that in 1996 underage drinking led to 3,500 deaths, 2 million nonfatal injuries, 1,200 cases of fetal alcohol syndrome, and 57,000 cases of treatment for alcohol dependence. Worse yet, underage drinking reaches into the future by impeding normal development and constricting future opportunities. Conservatively estimated, the social cost of underage drinking in the United States in 1996 was $52.8 billion (Pacific Institute for Research and Evaluation, 1999).

For many children, alcohol use begins early, during a critical developmental period: in 2002, 19.6 percent of eighth graders were current users of alcohol (use within the past 30 days), which can be compared with 10.7 percent who smoked cigarettes and 8.3 percent who used marijuana. Among each older age cohort of high school students, the prevalence, frequency, and intensity of drinking increase, contributing to increasing rates of educational failure, injury, and death as children move from grade to grade. By the time young people are seniors in high school, almost three-quarters (71.5 percent) report having drunk in the past year, almost half (48.6 percent) are current drinkers, and more than one-quarter (28.6 percent) report having had five or more drinks in a row in the past 2 weeks (Johnston et al., 2003). Among 18- to 22-year-olds, 41.4 percent of full-time college students and 35.9 percent of other young adults report heavy drinking (Substance Abuse and Mental Health Services Administration, 2002). Heavy childhood and teenage drinking injures the developing brain and otherwise interferes with important developmental tasks. In addition, children and adolescents who begin drinking early are more likely than others to wind up with alcohol problems throughout their adult lives.

The public is certainly aware of these problems, especially drunk driving by teens. However, recent surveys demonstrate that parents underestimate the prevalence and intensity of alcohol use by their own children and by the underage population (see Chapter 6 ). Moreover, as measured by media attention and government expenditures, public concern about teenage alcohol use has not been remotely commensurate with the magnitude of the problem. A telling measure of the current societal response is the large gap in the federal government’s investment in discouraging illicit drug use among teenagers and in discouraging underage drinking, given that the social damage from underage alcohol use far exceeds the harms caused by illicit drug use. In fiscal 2000, the nation spent approximately $1.8 billion on preventing illicit drug use (Office of National Drug Control Policy, 2003), which was 25 times the amount, $71.1 million, targeted at preventing underage alcohol use (U.S. General Accounting Office, 2001). The amount spent on preventing underage drinking also appears to be less than the amount spent on preventing tobacco use: in fiscal 2000, the Office of Smoking and Health, only one of many agencies in the Department of Health and Human Services concerned with smoking prevention, spent approximately $100 million. In addition, the states spent a great deal more, including funds generated by the agreement that settled the states’ Medicaid reimbursement suits against the tobacco companies.

There are signs that public attention to underage drinking is increasing and that the public recognizes the need to address the problem more aggressively than has thus far occurred. A recent study on public attitudes toward

underage drinking (Wagenaar et al., 2002) shows almost universal recognition of this problem. In fact, 98 percent of adults polled said they were concerned about teen drinking and 66 percent said they were “very concerned.” Moreover, a majority of respondents favored strong regulatory actions, such as additional controls on alcohol sales and advertising that would “make it harder for teenagers to get alcoholic beverages.” In 1999, Mothers Against Drunk Driving (MADD) added the goal of reducing underage drinking to its mission statement, and its activities and public statements increasingly reflect this focus (e.g., Mothers Against Drunk Driving, 2002). Underage drinking has also won the attention of the spouses of the nation’s governors, many of whom have come together to form the Leadership to Keep Children Alcohol Free, in collaboration with the Robert Wood Johnson Foundation (RWJF) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA, part of the National Institutes of Health). In collaboration with the American Medical Association (AMA), the RWJF has also provided long-term support to 12 community and 10 university-based coalitions with the specific mission of reducing and preventing underage drinking. The AMA has itself also become increasingly active on the issue of underage drinking, calling for tighter regulation of alcohol availability, higher excise taxes, and restrictions on alcohol advertising. Members of the alcohol industry also have continued their efforts to discourage underage drinking through responsible drinking campaigns and approaches such as server, parent, and youth-oriented education and involvement in prevention efforts on college campuses.

Underage drinking has also begun to attract increased government attention in Washington. The U.S. Federal Trade Commission (FTC), at the request of Congress, recently reviewed the alcohol industry’s advertising and marketing practices. Its report (U.S. Federal Trade Commission, 1999) called on alcohol companies to move toward the “best practices” in the industry “to reduce underage alcohol ad exposure.” In 2003 Congress called on the FTC to revisit its inquiry into alcohol advertising and youth and to investigate if and how the recommendations issued in its 1999 report have been implemented by the alcohol industry. Advocacy groups have also urged Congress to include underage alcohol use in the major media campaign being waged against illegal drug use under the auspices of the Office of National Drug Control Policy.

THE COMMITTEE STUDY

In 2001 Congress responded to the increasing level of public concern about underage alcohol consumption by appropriating funds for a study by The National Academies. Acting through the NIAAA and the Substance

Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services (HHS), Congress requested 1 The National Academies to undertake an examination of the pertinent literature, to “review existing federal, state, and nongovernmental programs, including media-based programs, designed to change the attitudes and health behaviors of youth,” and to “develop a cost effective strategy for reducing and preventing underage drinking.” Based on consultations with several of the Academies’ standing advisory boards, members of the Academies, and the Academies’ governing bodies, the final statement of task directs the committee to examine programs ranging from environmental interventions (e.g., taxation, access restrictions) to programs focusing directly on the attitudes and behavior of young people (see Appendix A for the full statement of task).

In response, the Board on Children, Youth, and Families (BCYF) of the National Research Council and the Institute of Medicine of the National Academies established a committee of 12 members with special expertise in key domains relating to underage drinking. To supplement the expertise of its members, the committee commissioned a set of papers to provide systematic reviews of the scientific literature on determinants of underage drinking and effective ways of reducing it. Topics explored in these papers include the demographics of underage drinking; its economic and social costs; adolescent decision making and risk and protective factors; and the effectiveness of various prevention programs and approaches, including media campaigns, school-based education, pricing, and access. Draft papers were presented at public meetings in October and November 2002 (see Appendixes B and C ) and subsequently reviewed and revised. 2

Numerous programs with the common goal of reducing underage drinking have been implemented at the national, state, and local levels, by governments and nonprofit and grassroots organizations. At the federal level, the Departments of Health and Human Services (HHS), Justice, and Transportation operate several programs that specifically target underage drinking. Seven other federal agencies fund efforts that include underage alcohol use within a broader mandate (U.S. General Accounting Office, 2001). Similarly, numerous state-level agencies administer programs to reduce underage drinking. In most states, the health, human service, transportation, criminal justice, and education departments play some role. State alcohol beverage control bodies also play a role. Many communities, colleges and universities, and grassroots organizations across the country have initiated

	Department of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2002, H.R. 3061.
	A select compilation of these papers is available as a CD-ROM attached to the inside back cover.

efforts to reduce underage drinking and its associated problems in their communities. The alcohol industry also has implemented a range of efforts with the goal of reducing underage drinking.

The committee reviewed the 2001 report of the General Accounting Office on federal programs. This report focused on federal funding that targets underage drinking or includes underage drinking within a broader mandate. It does not include evidence on the effectiveness of specific programs. For the programs operated by the Departments of Transportation and Justice, the report provides general information on the types of activities funded—traffic safety and enforcement of underage drinking laws, respectively. No information is provided on the HHS-funded programs or activities, the largest overall funder of targeted underage drinking activities (see Chapter 12 ), probably because the funds generally do not represent a national program but, rather, funding for select state or local programs or research aimed at specific aspects of the problem. Although HHS has funded evaluations of specific state and community-level programs, the committee is not aware of any national-level HHS evaluations, or national evaluations of the Department of Transportation program. Each of the federal agencies have initiatives to highlight promising practices, based on varying levels of evidence. Evaluations of state or local programs that receive federal funding that are available in the literature, are reflected in the papers prepared for the committee’s study.

The largest single federal program that targets underage drinking is the Enforcing the Underage Drinking Laws (EUDL) Program, operated by the Department of Justice’s Office of Juvenile Justice and Delinquency Prevention (OJJDP). A national evaluation of this program is in its fourth year, with only very preliminary outcomes information now available (see Chapter 9 ). The training and technical assistance center funded by the EUDL program produces a variety of materials that highlight best practices, many of which were reviewed by the committee.

The committee also reviewed written materials submitted by numerous organizations and individuals and considered both written and oral information presented at a public meeting held on November 21, 2002, by a wide range of organizations and people (see Appendix C ). This input highlighted programs or approaches considered effective by diverse communities and provided insights into their attitudes and experiences. The judgments provided through this process regarding effectiveness of particular programs or interventions were primarily subjective or based on informal evaluations.

Industry representatives provided extensive materials that were reviewed by the committee on the multiple activities they fund to reduce underage drinking. Included were descriptive materials such as summaries, brochures, pamphlets, videos, and guidebooks; testimonials from commu-

nity representatives on the utility of specific activities, and an evaluation of Alcohol 101, an industry-funded college-based intervention (see Chapter 7 for further discussion of these activities).

The committee’s basic charge is to provide science-based recommendations about how best to prevent and reduce underage drinking. Based on its expertise, consideration of public input, and review of the available scientific literature, including the papers written for the committee, the committee identified eight categories of programs or interventions and presents the evidence for each in the relevant chapter:

media campaigns designed to discourage underage drinking directly, to affect the behavior of adults, and to build a broader public awareness of the nature and magnitude of the problem ( Chapter 6 for adult-oriented campaigns and Chapter 10 for youth-oriented campaigns);

measures to curtail or counteract activities by individuals or businesses, including alcohol marketing practices, that tend to encourage or facilitate underage drinking (Chapters 7 and 8 );

measures restricting youth access to alcohol in both commercial and noncommercial settings, together with programs enforcing these laws ( Chapter 9 );

measures to reduce alcohol-related social harms by enforcing compliance with underage drinking restrictions, such as zero tolerance laws and other programs to reduce alcohol-related traffic injuries and criminal behavior ( Chapter 9 );

educational activities undertaken by schools, colleges and universities, faith-based institutions, healthcare organizations, alcohol companies, parent associations, and other entities designed to discourage underage drinking ( Chapter 10 );

community-based initiatives designed to tailor comprehensive approaches to the specific underage drinking problems of local communities ( Chapter 11 );

screening, counseling, and treatment programs to assist underage drinkers who have developed alcohol problems ( Chapter 11 ); and

methods of increasing the price of alcohol to underage purchasers, including increases in excise taxes ( Chapter 12 ).

It is important to recognize that implementation of any national “strategy” will depend on the cooperative actions of thousands of organizations and millions of individuals who have their own ideas about what is likely to be effective and valuable. These organizations include agencies at all levels of government (federal, state, and local) with an interest in underage drinking (e.g., alcoholic beverage control commissions, schools, and agencies responsible for law enforcement, substance abuse prevention, social ser-

vices, and public health). It also includes all the companies and establishments involved in producing, distributing, and selling alcohol—including distillers, vintners, breweries, package stores, and bars—as well as the advertising agencies that advise companies about how to position their products in different segments of the markets they seek to reach. It includes entertainment companies and other organizations that shape popular culture and affect young people’s attitudes about alcohol. A key role in any national response to the problem is played by parents who set models of drinking behavior for their children and who can affect the conditions under which their children have access to alcohol products. Of course, youths themselves make important decisions—not only about their own drinking, but also about how they view the drinking of their friends and peers.

The scope of the current efforts of many national, state, local, and nongovernmental group initiatives to prevent underage drinking or the consequences of drinking, particularly drinking and driving, is impressive. These programs include educational interventions, media campaigns, and activities to support enforcement of minimum drinking age laws. Young people themselves have organized efforts to discourage drinking among their peers. While few of these activities have been evaluated in any formal way, a successful national strategy will require the continued involvement, wisdom, and experience of the range of people and organizations that have been committed to preventing and controlling underage drinking.

A CHALLENGING TASK

The committee was charged with “developing a cost-effective strategy for preventing and reducing underage drinking.” As we set about this important task, it soon became evident that preventing and reducing underage alcohol use poses unusual challenges. Four of those challenges are the pervasiveness of drinking in the United States, the need for a broad consensus for a national strategy, ambivalence about goals and means, and commercial factors.

Pervasiveness of Drinking

Alcohol is readily available to adults (those over 21) through a large number of outlets for on-premise or off-premise consumption. About half of U.S. adults currently drink alcohol; among drinkers , the mean number of drinking days per month in 1999 was approximately eight. 3

Based on the committee’s analysis of 2000 data from the National Household Survey on Drug Abuse.

Notwithstanding the legal ban, alcohol is also readily available to underage drinkers. In recent surveys of high school students, 94.7 percent of twelfth graders and 67.9 percent of eighth graders reported that alcohol is “fairly” or “very” easy to get (Johnston et al., 2003). Purchase surveys reveal that from 30 to 70 percent of outlets may sell to underage buyers, depending in part on their geographic location (Forster et al., 1994, 1995; Preusser and Williams, 1992; Grube, 1997). Focus groups have also indicated that underage youths typically procure alcohol from commercial sources and adults or at parties where parents and other adults have left the youths unchaperoned (Jones-Webb et al., 1997; Wagenaar et al., 1993). Wagenaar et al. (1996) reported that 46 percent of ninth graders, 60 percent of twelfth graders, and 68 percent of 18- to 20-year-olds obtained alcohol from an adult on their last drinking occasion. Commercial outlets were the second most prevalent alcohol source for youths 18 to 20. For younger adolescents, the primary sources of alcohol are older siblings, friends and acquaintances, adults (through third-party transactions), and at parties (Harrison et al., 2000; Jones-Webb et al., 1997; Schwartz et al., 1998; Wagenaar et al., 1993). National surveys of college student drinking find that a large percentage of college youth report they do not have to pay anything for alcohol, presumably because they are at a party where someone else is supplying the alcohol (Wechsler et al., 2000).

American culture is also replete with messages touting the attractions of alcohol use, which often imply that drinking is acceptable even for people under 21. Recent content analyses of television showed that alcohol use was depicted, typically in a positive light, in more than 70 percent of episodes sampled from prime-time programs shown in 1999 (Christensen et al., 2000), and in more than 90 percent of the 200 most popular movie rentals for 1996-1997 (Roberts et al., 1999b). Roberts et al. (1999b) also found that 17 percent of 1,000 of the most popular songs in 1996-1997 across five genres of music that are popular with youth contained alcohol references, including almost one-half of the rap music recordings. Positive images are also disseminated by the alcohol industry, which spent $1.6 billion on advertising in 2001 and at least twice that amount in other promotional activity. Thus, overall, young people are exposed to a steady stream of images and lyrics presenting alcohol use in an attractive light.

Need for Consensus

An effective strategy to reduce a behavior as pervasive and widely facilitated as underage drinking will depend on a public consensus about both goals and means, which will require an unequivocal commitment from a broad array of public and private institutions. If the nation is to succeed in promoting abstention or reduced consumption by minors in a country

that has more than 120 million drinkers, the need to do so has to be understood and embraced by many people in a position to reduce drinking opportunities for minors. An effective strategy will depend on adoption of public policies by authoritative decision makers about how to use tax money and public authority—for example, whether to use federal dollars to fund a national media campaign, how to enforce existing state laws banning sales to underage drinkers, or how local school boards should discipline students who drink. The process of enacting such policies will require some degree of public consensus, but this is only the start.

Ultimately, the effectiveness of government policies will depend on how enthusiastically a great many public and private agencies join in the effort to implement them. If parents, animated by a national media campaign, join local police and school boards in concerted efforts to discourage underage drinking and if alcohol distributors join with regulatory agencies to find means to deny underage drinkers easy access to alcohol, then the impact of government policies will be increased. In short, a public consensus to deal determinedly and effectively with underage drinking is needed not only to generate support for adopting strong policies, but also to make them effective. Conversely, both enactment and implementation will be seriously impeded if the public is divided or ambivalent about the importance of reducing underage drinking.

It is here that the greatest challenge lies. In the nation’s diverse society, communities have differing beliefs and sensibilities about the consumption and social meaning of alcohol use in general, as well as about what should be expected and demanded of young people during the transition between childhood and adulthood. These differences contribute to varying beliefs, varying public policies, and varying individual practices regarding underage access to alcohol. Although the vast majority of families would agree that the nation as a whole has a powerful interest in reducing the negative consequences of underage drinking on society and on the youths themselves, individuals, families, groups, and communities all have different views on the wisdom and propriety of various approaches to the problem.

In this respect, surveys that show that certain steps by governments (e.g., increasing alcohol excise taxes or restricting advertising) are widely supported obscures disagreements about whether young people should be severely punished for using alcohol, whether parents should be punished for allowing parties with alcohol for youth in their homes, or whether the legal drinking age should be 21.

Ambivalence About Goals and Means

The problem of mustering a societal consensus to achieve an objective as subtle, complex, and contested as reducing underage drinking can be

seen most sharply when one compares underage drinking with illegal drug use and underage smoking. The goal of the nation’s policy toward illegal drugs and tobacco—abstention by everyone—is both unambiguous and widely, if not universally, embraced. Thus, the nation aims to discourage and suppress nonmedical use of marijuana, cocaine, and other controlled substances by everyone (whatever their age) through a comprehensive legal regime prohibiting the manufacture, distribution, and possession of these drugs for nonmedical purposes. Even though tobacco products, by contrast, are lawfully available to adults, the nation’s clearly expressed goal is to discourage tobacco use by everyone, by preventing initiation and promoting cessation. The messages to young people and adults in these two contexts are identical: indeed, because few people take up smoking as adults, the overall success of the nation’s anti-tobacco policy depends substantially on the success of its efforts to prevent initiation among young people.

The task of developing a strategy for preventing and reducing alcohol use among young people, in contrast, faces an uncertain policy goal. A strong cultural, political, economic, and institutional base supports certain forms of drinking in the society. Unlike the goals for illegal drugs and tobacco, the nation does not aim to discourage or eliminate alcohol consumption by adults. It is probably a fair characterization to say that the implicit aims of the nation’s current alcohol policy are to discourage excessive or irresponsible consumption that puts others at risk, while being tolerant of moderate consumption (at appropriate places and times) by adults (especially in light of the possible health benefits of moderate use for some populations over 40). For example, as long as others are not endangered or offended, attitudes toward intoxication (per se) vary according to religious beliefs and personal moral standards. In short, current alcohol policy rests on a collective judgment, rooted in the Prohibition experience, that the wisdom and propriety of alcohol use among adults should be left to the diverse moral judgments of the American people. This is not to say that everyone supports this stance of government neutrality. Many public health experts would like to take steps (short of prohibition) to suppress alcohol consumption as a way of reducing alcohol problems, and some conservative religious groups would take a more aggressive public stance against intoxication itself. However, the current stance of tempered neutrality seems to be widely accepted and therefore fairly stable.

In this policy context, the message to young people as well as adults about alcohol use is both subtle and confusing. The message to young people is “wait” or “abstain now,” rather than “abstain always,” as it is with tobacco and illegal drugs. Unlike the policies for those other products, the ban on underage alcohol use explicitly represents a youth-only rule, and its violation is often viewed as a rite of passage to adulthood. The problem

is exacerbated because the age of majority is higher for alcohol than it is for any other right or privilege defined by adulthood (e.g., voting, executing binding contracts). Explaining convincingly—to young people as well as adults—why alcohol use is permissible for 21-year-olds but not for anyone younger is a difficult but essential task for reducing or preventing underage drinking.

There is also confusion about whether messages to young people should emphasize abstention, perhaps drawing together alcohol, tobacco, and illegal drugs, or whether messages should focus on the dangers of intoxication and heavy drinking. Many people believe that abstention messages are more appropriate (and more likely to be effective) for younger teens than for older teens and college students.

This overall debate raises the same question posed by all wait rules: What is the age of demarcation between childhood and adulthood (see, generally, Zimring, 1982; Kett, 1977). The argument has been given a raw edge by the trend, in recent years, to curtail the jurisdiction of juvenile courts and to prescribe severe punishments, including the death penalty, for teenagers who commit crimes (Fagan and Zimring, 2000).

Commercial Factors

Alcohol is a $116 billion-per-year industry in the United States, catering to the tastes and needs of the more than 120 million Americans who drink. All states generate revenue from the sale of alcohol, either through excise taxes or product mark-ups, and 18 states participate in the alcohol market through retail and/or wholesale monopolies over distribution of certain alcoholic beverages. A strategy to suppress underage alcohol use must somehow be implemented in the very midst of a society replete with practices and messages promoting its use, and with a strong sector of deeply vested economic interests and the accompanying political and economic power. A significant level of underage use is inevitable under these circumstances—as an inevitable spillover effect, even if unintended by the industry—no matter what strategy is implemented. Foster et al. (2003) recently estimated that underage drinkers account for 19.7 percent of all drinks consumed and 19.4 percent of the revenues of the alcohol industry (about $22.5 billion). On the basis of the committee’s independent calculations, we conclude that youth consumption falls somewhere between 10 and 20 percent of all drinks and accounts for a somewhat lower, although still significant, percentage of total expenditures (see Chapter 2 ).

Although a similar challenge confronts tobacco control policy makers in the effort to prevent youthful use of tobacco products, the potency and impact of tobacco industry activity are gradually being lessened by the growing consensus that tobacco is a deadly and disapproved product, that

the industry has misled its customers for decades, and that aggressive regulation is needed to prevent young people from using tobacco and otherwise to protect the public health. It is generally believed that the tobacco industry has targeted young people to maintain demand for tobacco products as older consumers quit or die, notwithstanding the industry’s professed efforts, in the wake of the Master Settlement Agreement, to discourage underage use of their products. In short, public health officials and the major tobacco companies are not on the same side, and “big tobacco” is regarded as the enemy of the public’s health.

In contrast, the alcohol industry is diverse and uniformly acknowledges the dangers of underage drinking. Alcohol experts generally assume that the level of adult demand for alcohol products will not be substantially affected, over the long term, by reducing underage consumption—although getting young people to wait will obviously reduce the overall level of consumption. Thus, while the commercial interests of the alcohol industry are not perfectly aligned with the public health, they are not as antagonistic to the public health as the interests of the tobacco industry. In any case, a strategy for preventing and reducing underage drinking will have a much better chance for success if it attracts the active cooperation, and at least the acquiescence, of various segments of the alcohol industry.

The effectiveness of any policy focused explicitly on reducing underage drinking will be limited by the existence of a large legitimate practice of drinking and by the power of a large industry responding to legitimate consumer demand. When alcohol is available in many home liquor cabinets, the success of strategies to discourage young people from buying at package stores will be much different than in a world where relatively few parents have stocks of alcohol. The widespread legal use of alcohol in the society affects not only cultural and individual attitudes toward drinking, but also the extent to which any youth-oriented control regime can be effective in reducing opportunities for youths’ access to alcohol and drinking opportunities. One can establish a clear-cut boundary between acceptable drinking and unacceptable drinking at conceptual, policy, and legal levels, but it must be understood not only that different communities will construct that boundary differently as a matter of policy but also that the scope created for legal drinking has a profound, practical effect on the effectiveness of other policy instruments in discouraging unwanted, underage drinking.

In sum, the committee set about its task of developing a strategy for preventing and reducing underage drinking while being fully aware of the complexity of defining the public interest in this area and mindful of the severe constraints within which the strategy must be framed and implemented.

UNDERLYING ASSUMPTIONS

In conducting its work, the committee did not begin with a blank slate. Instead, we were asked to develop a national strategy given the basic framework of the nation’s current policy toward underage drinking. That policy aims to delay drinking by young people as long as possible and forbids lawful access to alcohol for people under 21.

Some people argue that the delay strategy is misguided and that the legal drinking age should be lower than 21 (typically 18). According to this view, allowing drinking at younger ages would mitigate youthful desire for alcohol as a “forbidden fruit”; would provide opportunities to “learn” to drink, thereby reducing harms; and would bring the age at which youth are allowed to drink into alignment with the age at which they can join the military, vote, and participate in other aspects of adult life. Whatever the merits of this view, the committee believes that Congress intended us to work within the framework of current law, anchored in the National Minimum Drinking Age Act of 1984, and that reconsideration of the 21-year-old drinking age, and of the premises on which it is predicated, is beyond our mandate. Moreover, as a practical matter, the current policy framework, though disputed by some, rests on a strong scientific foundation, is widely accepted, and is certain to be preserved for the foreseeable future.

Because the current policy framework provides the foundation for the committee’s work, and for the strategy recommended in this report, it is useful to summarize it here and to highlight its basic rationale.

Evolution of Current Policy

Until the last decades of the 19th century, society relied largely on nonlegal mechanisms of social control to constrain youthful drinking. However, in the wake of urbanization, immigration, and industrialization, alcohol came under tighter control, including bans against selling it to people under the legal age (Mosher et al., 2002). After the repeal of Prohibition in 1933, it became settled that decisions about alcohol control rested with the states, and the structure of modern alcohol regulation took shape.

Until 1970, the minimum drinking age in most states was 21. Between 1970 and 1976, 21 states reduced the minimum drinking age to 18, and another 8 states reduced it to 19 or 20 (usually as part of a more general statutory reform reducing the age of majority to 18) (Wagenaar, 1981). Proposals to restore a higher age were soon introduced, however, largely because alcohol-related automobile crashes had significantly increased among teenagers and young adults. Of the 29 states that lowered their drinking age, 24 raised the age again between 1976 and 1984. By that time, only three states allowed 18-year-olds to drink all types of alcoholic bever-

ages, while five others (including the District of Columbia) allowed 18-year-olds to drink beer and light wine while setting the age limit for distilled spirits and wine with high alcohol content at 21. Thirteen states set a uniform age of 19, and four others allowed 19-year-olds to drink beer and set the limit at 21 for other alcoholic beverages. Four states set the age at 20 for all alcohol, and the remaining 22 states set a uniform age of 21 (Bonnie, 1985).

In 1984 Congress enacted the National Minimum Drinking Age Act, as recommended by the Presidential Commission on Drunk Driving, using the threat of withholding 10 percent of federal highway funds to induce states to set the minimum drinking age at 21 for all alcoholic beverages. All states eventually complied and have a variety of mechanisms in place to enforce this restriction

The Goal of Delay

The explicit aim of existing policy is to delay underage alcohol use as long as possible and, even if use begins, to reduce its frequency and quantity as much as possible. Most people recognize that drinking itself is not the issue. Rather, the underlying challenge is protecting young people while they are growing up. Children and adolescents need to be protected in the first instance from the immediate harms that can occur when they are drinking. But they also need to be protected from the possibility that they will mortgage their own future prospects by initiating practices that could cause them permanent harm during a critical developmental period and that could lead to patterns of drinking that will worsen as they grow older.

The question is how best to go about that protective task. As indicated, some people argue that the most sensible approach is to permit drinking by young people (at least older teens) rather than trying to suppress it. In their view, a “wait” rule is not the best way to reduce the problems associated with underage drinking—at least in a society in which it is bound to occur with considerable frequency anyway. They would allow youthful drinking and focus on supervision rather than drinking per se (at least for older adolescents). In their view, a “learner’s permit” for drinking is preferable to a prohibition that drives underage drinking into the shadows and sacrifices the opportunity for supervision. A learner’s permit approach could be implemented in a variety of ways, such as by permitting youth access to only certain kinds of alcohol during the learning period (analogous to a graduated driving license) and by prescribing particular requirements for adult supervision.

If the drinking age were lowered, the critical question is whether the intensity of youthful drinking, and the accompanying problems, would decrease, as contended by proponents of the learner’s permit approach.

Admittedly, the current approach may create incentives for heavy unsupervised drinking on the occasions where alcohol is available. However, as discussed in Chapter 9 , young people who drink tend to do so heavily even in societies with a learner’s permit approach.

In addition, a substantial body of scientific evidence shows that raising the minimum drinking age reduced alcohol-related crashes and fatalities among young people (Cook and Tauchen, 1984; U.S. General Accounting Office, 1987; Wagenaar and Toomey, 2002) as well as deaths from suicide, homicide, and nonvehicle unintentional injuries (Jones et al., 1992; Parker and Rebhun, 1995). Increasing the minimum drinking age to 21 is credited with having saved 18,220 lives on the nation’s highways between 1975 and 1998 (National Highway Traffic Safety Administration, 1998). Voas, Tippetts, and Fell (1999), using data from all 50 states and the District of Columbia for 1982 through 1997, concluded that the enactment of the uniform 21-year-old minimum drinking age law was responsible for a 19 percent net decrease in fatal crashes involving young drivers who had been drinking, after controlling for driving exposure, beer consumption, enactment of zero tolerance laws, and other relevant changes in the laws during that time.

These findings reinforce the decision by Congress to act in 1984. In short, current national policy rests on the view, supported by substantial evidence, that delaying drinking reduces problem drinking and its consequences. The nation’s legislators and public health leaders have reached the nearly uniform judgment that the benefits of setting it at 21 far exceed the costs of doing so.

The Instrumental Role of the Law

Our earlier comparison among alcohol, tobacco, and illegal drugs raises another important preliminary question—about the role of the law in the prevention of underage drinking. It is possible to imagine an official policy aiming to delay and discourage underage drinking that does not rely in any way on the coercive authority of the state to implement this policy: instead of banning underage access to alcohol by law, society might rely entirely on parenting, education, community expectations, and other mechanisms of social control to suppress youthful drinking and, for older teens, to transmit the desired drinking-related norms and to encourage adults to refrain from supplying youths with alcohol or otherwise facilitating their drinking. Various forms of social disapproval, including social and economic sanctions (e.g., not patronizing stores or bars that serve minors) can be imagined.

In contrast, the United States has decided that there must be laws against supplying alcohol to young people and that it should also be illegal for young people to possess or use alcohol, at least in public. Thus, because

the law plays such a central role in the nation’s policy toward underage drinking, it is essential to clarify the functions that these laws should reasonably be expected to serve.

At the outset, it should be emphasized that a secular society seeks to delay underage drinking because it is dangerous to youths and others, not because it is inherently evil or wrong. The ban on underage drinking is an age-specific prohibition, implying that the aim is to delay alcohol use, not to condemn it or inoculate against it. For this reason, the prohibition is distinctly instrumental in nature and is not grounded in the moral disapproval that characterizes many legal prohibitions. To use a traditional legal classification, underage drinking is an example of a prohibition that is malum prohibitum (wrong because it is prohibited) rather than malum in se (wrong in itself). Punishment for an underage drinker, or even for an adult facilitator, is not an expression of public moral condemnation as is, for example, punishment for child sexual abuse or robbery.

Enforcement of prohibitions against immoral behavior serves the twin goals of reducing the harmful behavior and condemning and punishing the perpetrator for the transgression. The prohibition of underage drinking does not aim to serve this second (retributive) objective in any strong sense. Its aim is exclusively instrumental. Consequently, the measure of the prohibition’s effectiveness, and of the social policy it implements, has to be whether it reduces or avoids the dangerous consequences associated with youthful drinking.

Law is a blunt instrument. It is not self-executing, and it requires the affirmative support of a substantial proportion of the population and of those who are expected to enforce it. These characteristics of a law are particularly important for instrumental prohibitions, such as the ban against underage drinking, because the level of compliance will depend heavily on the willingness of a large number of individuals to adhere to the law simply because they accept its moral authority to command their obedience. That is, a legal norm of this kind, which affects so many people in so many everyday social and economic contexts, cannot be successfully implemented based on deterrence (the threat of punishment) alone. It must rely heavily on the “declarative” or “expressive” function of the law: by forbidding the conduct, it aims to shape people’s beliefs and attitudes about what is acceptable social behavior and thereby to draw on their disposition to obey.

Since the ultimate goal is to protect youths (and others within the zone of danger) from harmful consequences, one might wonder whether it is possible to implement an underage alcohol policy by focusing exclusively on the dangerous behavior rather than the drinking itself. In theory, it might be possible to define the prohibited conduct exclusively in relation to the magnitude of the risk: for example, “don’t drive a car after having had alcohol” or “don’t give alcohol to a youth who intends to drive a car or is

otherwise likely to behave dangerously.” However, any such dangerous drinking prohibitions are extremely difficult to implement successfully and would not exert a sufficient deterrent by themselves to prevent the risky behaviors associated with underage alcohol use. As the nation’s lawmakers have concluded, only a categorical prohibition of underage access to alcohol has any realistic chance of doing that, especially in a large industrial society in which the risks are pervasive (and magnified by developmental vulnerability) and where young people have large periods of time outside parental supervision and outside the reach of formal social controls. It is also relevant to note that at least one of the risks associated with underage drinking is intrinsic to the drinking itself—the permanent damage of alcohol consumption on the adolescent brain (see Chapter 3 ).

Given an age-based categorical prohibition aiming to serve exclusively instrumental aims, other policy judgments are needed regarding the scope of the restrictions, the severity of the prescribed sanctions, and the resources and tools that should be used to enforce the law. Banning commercial distribution of alcohol to underage persons is an essential element of the prohibition, but what about noncommercial distribution? Even if noncommercial distribution is banned, what about parental distribution to their own children in their own home? (Many states do not prohibit this distribution.) Is it also necessary to penalize young people who purchase or consume alcohol? Even in their own homes? What enforcement strategies should be used? And how severe should the sanctions be? These issues are addressed in Chapter 9 . The answers require careful assessment of the possible benefits (in reducing harms associated with underage drinking) and the costs of any particular strategy. The degree of public support and the difficulty of enforcement bear on both the potential effectiveness and on the possible costs.

A POPULATION PERSPECTIVE

In requesting the National Academies to develop a strategy for reducing and preventing underage drinking, Congress clearly anticipated that we would do so from a public health perspective, reviewing the etiology and consequences of alcohol use by the underage population and assessing the effectiveness of interventions that might be deployed to reduce the prevalence of drinking in this population, particularly the patterns of consumption most clearly associated with alcohol problems. (The outcomes of interest in assessing the effectiveness of interventions are discussed in Chapter 5 .) Recognizing that underage drinking substantially increases the short-term risks of death, injury, and other harms, as well as long-term risks of alcoholism and other dysfunction, a population-oriented strategy aims to lower the mean level of risk in the underage population in order “to shift

the whole distribution of exposure in a favorable direction,” typically by “altering some of society’s norms of behavior” (Rose, 1985, p. 371). Accordingly, we emphasize the population-oriented tools of primary prevention, rather than the individually oriented methods of secondary or tertiary prevention. Thus, identification and treatment of youths with drinking problems, or at high risk for developing such problems, and the challenge of instilling habits of responsible drinking as young people mature are addressed only incidentally in this report. These issues are important for improved policy and practice, but they are peripheral to our basic charge—delaying underage drinking and reducing its prevalence.

In developing a strategy to delay and reduce underage drinking, the committee has tried to understand the problem from two angles. First, we looked at the problem from the viewpoint of a young person deciding whether and under what circumstances to use alcohol. Our framework draws on the developing literature regarding adolescent decision making, especially in relation to health and risk behaviors. We pay particular attention to youthful decision-making abilities at various ages in the context of the changing social realities of teenage alcohol use. Some components of a comprehensive strategy must aim to help young people make the right decisions, depending on their age and developmental stage, taking account of the dangers of alcohol use at varying points in development.

It is not enough, however, to try to persuade young people to make the right choices. If the strategy relied exclusively on tools directed at changing the attitudes and behavior of underage youths, it would not have much chance of succeeding. To complement a youth-centered decision-making perspective, the committee also drew on the multidisciplinary perspective used by public policy analysts. This framework combines the disciplines of epidemiology, economics, health communications, law, and other social sciences to envision the array of policy instruments that can be brought to bear on the problem and to assess their probable effectiveness and costs, used alone or in combination.

OVERVIEW OF THE REPORT

Although the committee’s recommended strategy responds to a congressional request, the report is intended for a broad audience, including parents, businesses, alcohol companies, educators, state and local policy makers and legislators, healthcare producers and retailers, practitioners, and community organizers. Our work is presented in two parts.

Part I , Chapters 2 through 4 , provides important contextual information about underage drinking and its consequences and determinants. Chapter 2 discusses key definitions and presents pertinent demographic and epidemiological data regarding the scope of underage drinking and the

characteristics of underage drinkers. It includes data on the prevalence of alcohol use and drinking behavior by gender, race, and ethnicity as well as comparisons of youth and adult drinking patterns. Chapter 3 provides an account of the social consequences and costs of underage drinking.

Chapter 4 offers a context for the underlying reasons, motivations, social influences, and risk factors that influence young people’s decisions about drinking. The chapter explores the specific motivations and influences relevant to young people’s drinking behavior and attempts to answer why some young people choose to drink and do so intensively while others choose to drink moderately or not at all. The chapter also discusses the social environment in which young people are immersed and the ways that community and social factors affect underage drinking.

Part II , Chapters 5 through 12 , presents the committee’s recommended strategy to prevent and reduce underage drinking. In each of these chapters, the committee summarizes what is known about the effectiveness of existing programs or interventions in the pertinent domain and presents its conclusions and recommendations. The committee has tried to be realistic in assessing the potential effectiveness of efforts to prevent and reduce underage drinking. The committee assumes that most adults in the United States will continue to use alcohol and that most drinkers will begin their alcohol use sometime before they are 21, despite laws and policies to the contrary. Within that constraint, however, there is substantial room for preventing and reducing underage drinking in the United States, and this part of the report explores various tools that can be used in this effort.

At the heart of the committee’s proposed strategy is the effort to foster a collective societal acceptance of responsibility for reducing underage drinking. Although continued efforts to speak directly to young people about the dangers of alcohol use are an important component of the committee’s proposed strategy, the committee believes that the highest priority should be given to changing the attitudes and behaviors of adults. Adults often facilitate or enable underage drinking directly by supplying alcohol to young people, by failing to take effective precautions to prevent it, or by sending the message that alcohol use is to be expected. Few programs currently seek to influence parents to alter their behaviors and attitudes toward youth drinking as a way of reducing youth access to alcohol, changing permissive social norms about underage drinking, and galvanizing community action.

In Chapter 5 we explain our interpretation of the committee’s charge and some of the key assumptions underlying the strategy, including the criteria for assessing effectiveness and cost. This chapter is the foundation for the rest of the report. In Chapter 6 we discuss development of a national media effort as a major component of a campaign aimed at educating parents and other adults about underage drinking and ways adults can help

reduce opportunities for youth drinking. In Chapter 7 we discuss how the alcoholic beverage industry can become a partner in the overall effort by helping to establish and fund an independent nonprofit organization charged with reducing underage drinking and by exercising greater self-restraint in advertising and promotional activity. Our messages to the alcohol industry (and other industries that benefit from a large alcohol market) are clear: Your efforts to satisfy and expand the legitimate adult market for alcohol inevitably spill over to a large underage market. Even if you do not intend to stimulate or satisfy underage demand, you derive financial benefits from it. As a society, we cannot have a substantial impact on underage drinking without your active engagement in this effort. Chapter 8 issues a similar challenge to the entertainment media, urging more attentive self-regulation to reduce exposure of children and adolescents to lyrics and images that portray drinking in an attractive way. The committee believes that market incentives can be used to reward companies, including entertainment media, who take meaningful steps to help reduce underage drinking, and to punish companies that do not. Chapter 9 explores ways to reduce youth access to alcohol through both commercial and noncommercial channels.

Chapter 10 explains why the committee does not recommend a youth-oriented national media campaign at this time, preferring instead a cautious program of research and development. It also addresses educational efforts in schools, colleges, and other settings designed to persuade young people to choose not to drink and to reduce alcohol problems. The chapter also briefly discusses programs for assisting youths with alcohol problems. Chapter 11 reviews the potential advantages of mobilizing communities to implement locally specific efforts to reduce underage drinking.

Chapter 12 identifies several ways in which the federal and state governments can help implement the proposed strategy, including through increases in excise taxes. Regulatory action by the government is not at the center of the committee’s proposed strategy. The major priority, in the committee’s view, is to galvanize the necessary societal commitment to prevent and reduce underage drinking. Thus, the committee focuses its attention on community action, business responsibility, public-private partnerships, and all the other institutional expressions of a genuine social movement. In this context, government has a supportive, but nonetheless indispensable, role—to provide funding (possibly through increased excise taxes on alcohol) and technical support to strengthen and enforce access restrictions, to keep regulatory pressure on the alcohol industry to act responsibly, and to monitor the effectiveness of the overall strategy.

Alcohol use by young people is extremely dangerous - both to themselves and society at large. Underage alcohol use is associated with traffic fatalities, violence, unsafe sex, suicide, educational failure, and other problem behaviors that diminish the prospects of future success, as well as health risks – and the earlier teens start drinking, the greater the danger. Despite these serious concerns, the media continues to make drinking look attractive to youth, and it remains possible and even easy for teenagers to get access to alcohol.

Why is this dangerous behavior so pervasive? What can be done to prevent it? What will work and who is responsible for making sure it happens? Reducing Underage Drinking addresses these questions and proposes a new way to combat underage alcohol use. It explores the ways in which may different individuals and groups contribute to the problem and how they can be enlisted to prevent it. Reducing Underage Drinking will serve as both a game plan and a call to arms for anyone with an investment in youth health and safety.

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Home > UCHC > UCHC EDU > UCHC Grad School > UCHC GS Theses > 128

UCHC Graduate School Masters Theses 2003 - 2010

Underage Alcohol Consumption in the United States: Associations with Access Laws, Alcohol Excise Taxes and Enforcement Practices

Matthew J. Cook , University of Connecticut - Storrs

Document Type

Disciplines

Medicine and Health Sciences

This thesis, in fulfillment of the Masters requirements in Public Health, examines underage alcohol consumption in the United States and its association with retail and social access laws, alcohol excise taxes, and enforcement. The study objectives are to assess the availability and quality of consumption and policy data at the state level, describe the number and type of alcohol access policies enacted in the states since 1998, determine whether the number of exemptions placed on alcohol access policies are related to state underage drinking patterns across states, determine if two social access polices ⎯ keg registration and social host criminal liability laws ⎯ are associated with underage drinking rates, determine if liquor law enforcement is associated with rates of past month underage alcohol use, and determine the relationship between alcohol excise taxes and underage drinking. This study includes a secondary analysis of consumption and policy data from the National Survey on Drug Use and Health (NSDUH), Alcohol Policy Information System (APIS), Uniform Crime Reports, and the Tax Foundation’s state alcohol excise tax tables. Analysis of variance and regression using general linear modeling reveal two key findings: 1) keg registration, enforcement and beer excise taxes were associated with past month underage drinking rates; 2) neither social host laws nor the number of exemptions to youth alcohol access laws are associated with underage drinking. Lack of population-based consumption data over time limits the analysis crossectionally. Policy implications and areas for future research are discussed.

Recommended Citation

Cook, Matthew J., "Underage Alcohol Consumption in the United States: Associations with Access Laws, Alcohol Excise Taxes and Enforcement Practices" (2008). UCHC Graduate School Masters Theses 2003 - 2010 . 128. https://digitalcommons.lib.uconn.edu/uchcgs_masters/128

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Alcohol Use and Your Health
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About Underage Drinking

Alcohol is the most common drug used by people younger than 21 in the United States.
Young people who drink alcohol are more likely to develop certain physical and mental health conditions.

These deaths, which could have been prevented, take the lives of young people too soon.
Underage drinking cost the United States $24 billion in 2010 (the most recent year of data available). B 2

Effects of underage drinking

Alcohol is the most common drug that young people use in the United States. 3

Young people who drink alcohol are more likely to engage in risky behaviors that can lead to injuries and other health conditions. They're also more likely to experience social, academic, and legal issues.

Social, academic, and legal issues:

More school absences.
Lower grades.
Drinking and driving, which puts the safety of those who drink—as well as those around them—at risk.
Misusing prescription drugs or using illicit drugs—there can be serious health effects when using these drugs with alcohol .

Physical and mental conditions:

Violence, including homicide, suicide, and sexual violence.
Injuries including alcohol-related motor vehicle crashes , burns, falls, or drowning.
Not growing as expected.
Slower brain development—which may cause problems with memory.
Protection includes using condoms or taking medicine to prevent STIs, HIV, or pregnancy.

Lastly, people who start drinking earlier in life have a higher risk of developing alcohol use disorder later in life.

What the data show

Adult alcohol use can increase underage drinking.

Adolescents tend to drink if the adults around them drink or binge drink alcohol.

For example, a study showed that adolescents whose parents drank 5 or more days in a month were significantly more likely to drink alcohol than adolescents whose parents didn't drink. 4

Parent with arm around child. Text says, Adolescents are 4 times more likely to drink alcohol if their parents binge drink.

Alcohol is the most common drug young people use

Also, 11% of high school students reported binge drinking during the past month. 3

In recent years:

Alcohol use and binge drinking among high school students have generally decreased in recent decades. 5
This is a shift from previous years when boys drank more than girls. 5

Some young people also report drinking and driving

More than 1 in 10 high school students reported riding in the past month with a driver who had been drinking alcohol. 3
About 5% of high school students who had driven in the past month said they drove after drinking alcohol. 3

Learn more about:

How proven alcohol policies can prevent alcohol-related harms.
This includes strategies that can support young people's development by reducing underage drinking.
The alcohol policies in your state .
During 2020-2021.
These costs have likely increased because of factors like inflation and increased health care and public safety costs. However, this cost estimate still provides an idea of the minimum costs of underage drinking.
Centers for Disease Control and Prevention. Alcohol-Related Disease Impact application. Accessed March 21, 2024. www.cdc.gov/ardi
Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 national and state costs of excessive alcohol consumption. Am J Prev Med 2015; 49:e73–e79. doi: 10.1016/j.amepre.2015.05.031
Centers for Disease Control and Prevention. 2021 Youth Risk Behavior Survey Data. Accessed September 13, 2023. http://yrbs-explorer.services.cdc.gov/
Bohm MK, Esser MB. Associations between parental drinking and alcohol use among their adolescent children: findings from a national survey of United States parent-child dyads. J Adolesc Health . 2023;73(5):961–964. doi: 10.1016/j.jadohealth.2023.05.028
Hoots BE, Li J, Hertz MF, et al. Alcohol and other substance use before and during the COVID-19 pandemic among high school students — Youth Risk Behavior Survey, United States, 2021. MMWR Suppl. 2023;72(Suppl 1):84–92. http://dx.doi.org/10.15585/mmwr.su7201a10

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Peer-reviewed

Research Article

Alcohol consumption in early adolescence: Associations with sociodemographic and psychosocial factors according to gender

Roles Conceptualization, Data curation, Formal analysis, Investigation, Writing – original draft

* E-mail: [email protected]

Affiliation Service d'Information, Promotion, Éducation Santé (SIPES), Research Centre in “Epidemiology, Biostatistics and Clinical Research”, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium

Roles Data curation, Resources, Writing – review & editing

Affiliations Service d'Information, Promotion, Éducation Santé (SIPES), Research Centre in “Epidemiology, Biostatistics and Clinical Research”, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium, Research Centre in “Social Approaches to Health”, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium

Roles Data curation, Investigation, Writing – review & editing

Roles Conceptualization, Funding acquisition, Project administration, Supervision, Writing – review & editing

Camille Pedroni,
Maud Dujeu,
Thérésa Lebacq,
Véronique Desnouck,
Emma Holmberg,
Katia Castetbon

Published: January 15, 2021
https://doi.org/10.1371/journal.pone.0245597
Reader Comments

Introduction

Early alcohol consumption can irreversible damage the adolescents’ brain and may affect their quality of life. In order to better prevent such a deleterious behaviour, knowing its determinants is needed. So far, only few studies among adolescents aged <15 years exist, of which the majority failed to include gender differences. Therefore, the aim of this study was to investigate whether gender differences in the association between alcohol use and sociodemographic and psychosocial characteristics among 10-14-year olds exist.

Data came from the 2018 Health Behaviour in School-Aged Children (HBSC) study conducted in French-speaking schools of Belgium. The sample analysed here comprised 4,364 10-14-year olds from the Walloon Region. Associations of the recent alcohol consumption (at least one glass during the past month) with sociodemographic and psychosocial characteristics were estimated using gender-stratified multivariable logistic regression modelling.

Prevalence of early alcohol consumption was 14% (boys: 16%; girls: 12%). Migration status and family affluence scale (FAS) were associated with early alcohol consumption only in boys. Second-generation immigrant boys (vs. natives: OR = 0.66 [0.47–0.92]) and boys from “low” FAS families (vs. “high”: OR = 0.56 [0.32–0.98]) or “medium” FAS (vs. “high”: OR = 0.63 [0.43–0.92]) were less likely to have consumed alcohol in the past month. In both genders, alcohol consumption was positively associated with age and inversely associated with school satisfaction and family support. No association was observed with family structure, peer support and life satisfaction in the multivariable models.

Our findings showed that gender differences may exist in the determinants of alcohol consumption among young adolescents. They will contribute to the development of public health policies and actions for the most vulnerable adolescents, which should take gender differences into account.

Citation: Pedroni C, Dujeu M, Lebacq T, Desnouck V, Holmberg E, Castetbon K (2021) Alcohol consumption in early adolescence: Associations with sociodemographic and psychosocial factors according to gender. PLoS ONE 16(1): e0245597. https://doi.org/10.1371/journal.pone.0245597

Editor: Michel Botbol, Universite de Bretagne Occidentale, FRANCE

Received: June 24, 2020; Accepted: January 5, 2021; Published: January 15, 2021

Copyright: © 2021 Pedroni et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The Office of Birth and Childhood (ONE), the Walloon region and the French community commission (COCOF) provided financial support for the French-speaking HBSC survey in Belgium. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

1. Introduction

Adolescence is a key period in life characterized by many social, physical, physiological and psychological changes which may make adolescents particularly vulnerable to the adverse consequences of risk-taking behaviours, including alcohol use [ 1 ]. A report based on the 2014 Health Behaviour in School Aged Children (HBSC) survey data in 36 countries and regions in Europe and North-America [ 2 ] has shown that among 15-year-old adolescents, 28% had first started consuming alcohol at age 13 or younger (31% of boys and 25% of girls). Boys were more likely to report early alcohol initiation in most countries and regions. In the French-speaking schools of Belgium (Walloon Region and Brussels-Capital Region), one quarter of boys and one girl in five had consumed alcohol at age 13 or younger [ 2 ].

An “early alcohol consumption” is generally defined as having drunk before the age of 15 [ 3 ]. Starting to drink alcohol at such a very young age carries a variety of specific health risks, especially for the brain development [ 4 , 5 ]. In addition, early alcohol use, when compared with an initiation in later adolescence, is associated with a raise in the frequency and in the quantity of alcohol consumed, and with more frequent alcohol-related troubles in later adolescence and early adulthood [ 6 , 7 ]. However, while drinking habits are well documented in adolescents aged 15 years and older, studies on drinking habits in adolescents under the age of 15 are scarce, despite the specific risk of negative health-related consequences in this age group [ 8 , 9 ]. As a result, the determinants of early alcohol use are barely known. These determinants are related to five domains: individual, family, peer, school and community [ 10 ]. The family- and peer-domains have been most studied [ 11 – 13 ]. For instance, parents’ and friends’ alcohol use, peer encouragement toward consumption, or low parental monitoring have been identified as risk factors for early alcohol use [ 11 – 13 ]. The risk factors related to the other three domains have been much less studied.

Moreover, gender disparities in various health and risk behaviours in adolescence have been identified [ 14 – 16 ]. Another HBSC research showed, among other disparities, that girls were more likely than boys to report high levels of perceived peer support, high satisfaction with school, ate more fruits, but described fair or poor health and lower life satisfaction [ 14 ]. In turn, boys were generally reporting more positive relationships, and physical activities, but also more frequent injuries and sedentary behaviours [ 14 ]. Regarding drinking behaviors, gender differencies have been highlighted in the determinants of early alcohol use. For instance, having a secure attachment to parents and to peers was a protective factor against early alcohol use but only for girls [ 17 ]. Similarly, among girls only, a higher level of perceived parental monitoring was associated with lower odds of early alcohol consumption [ 18 ]. However, for associations related to the other three domains (individual, school and community), too few data exist to draw robust conclusions on gender-related derterminants.

In order to complete the knowledge on this topic, the aim of this study was to identify potential gender differences in the associations between alcohol use and sociodemographic and psychosocial characteristics among adolescents aged 10 to 14 years. This knowledge will be helpful to the development of actions targeted to young consumers of alcohol, to avoid serious adverse impact on their current and future quality of life.

2. Materials and methods

2.1. sample.

We used data collected for the 2018 HBSC cross-sectional survey conducted in the French-speaking schools of Belgium. The HBSC study is conducted in almost 50 countries and regions using an international standardized protocol [ 19 ]. The study is undertaken every four years in the French-speaking schools of Belgium (Walloon Region and Brussels-Capital Region). Children and adolescents were asked about their health status, wellbeing and health-related behaviours through self-administered questionnaires they filled out in the classroom according to a standardized procedure, and treated as confidential and anonymous [ 20 ]. The protocol was approved by the educational authorities of each school network (private and public) and by the ethics committee of the Faculty of Psychology of the Université libre de Bruxelles (ethics opinion n°032/2017) .

A two-stage random sample was used. First, schools were randomly selected from an official list of all schools stratified per province and school network, using an allocation proportional to the school population size of each province and network. Among the 807 schools invited to participate, 266 took part in the survey, with a participation rate of 33%. Secondly, one class per grade was randomly selected in the participating schools. All selected classes were willing to participate.

In an operational point of view, a letter introducing the survey was sent to the head of each selected school. This letter contained a form to be completed to notify agreement or refusal. The schools for which no feedback was received were contacted by phone or e-mail. Then, each participating school filled out informations about the classes (number of students, education branch…) which was used to randomly select them. In addition, each school was asked to designate a coordinator to handle the distribution and retrieval of the survey materials (survey questionaires, information letters, general instructions…) and to transmit them to the research team.

Adolescents and their parents received an information letter about the study objectives, the topics covered, the confidentiality and anonymity of the data collected, and their right to refuse to participate. Parents could express their refusal for the participation of their child. On the day of the questionnaire completion, adolescents also still had the opportunity to refuse to participate in the survey. The sample included all students in the selected classes, who were present on the day of questionnaire completion and who agreed to fill it in. In all selected classes, 87.0% of the students agreed to participate and eventually completed the questionnaire.

The entire 2018 HBSC sample was composed of 14,407 adolescents of 10 to 21 years of age ( Fig 1 ) . Adolescents older than 14 years of age and those who attended schools in the Brussels-Capital Region were excluded from the study sample (n = 8,489). Since the two regions include very different population structure and lifestyle (in relation with socioeconomic and cultural characteristics), analyses were here restricted to Wallonia. Those who had missing values for one or more study variables were also excluded from the analyses (n = 1,554). The final sample therefore included 4,364 adolescents aged 10 to 14 years from Walloon schools ( Fig 1 ) .

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2.2. Measures

2.2.1 alcohol consumption..

The question on alcohol consumption was: “On how many days (if any) have you drunk alcohol in the last 30 days (at least a glass of beer, wine, cocktail, aperitif…)?” Seven-answer options ranged from “never” to “30 days” [ 21 ]. The parenthesis was added to avoid that only sipping was accounted for by the respondants, since it has previously been shown that the youngest not really drink full glasses but only take small amount of alhoholic beverages [ 22 ]. Respondents were classified into two categories: adolescents who consumed alcohol at least one day during the last 30 days versus those who did not consume alcohol during the last 30 days.

2.2.2 Family & peer support.

Family and peer support was assessed through a four-item scale from the « Multidimensional Scale of Perceived Social Support » (MPSS), whose internal coherence and factorial validity have been demonstrated, especially among adolescents [ 23 , 24 ]. Family support scale included statements such as “I can talk about my problems with my family” and the peer support scale, “I can count on my friends when things go wrong”. For both scales, a five-point Likert scale ranging from “strongly agree” to “strongly disagree” was given for each item. The four-item scores were summed and the sum was divided into three categories: “low” support (1 to 2.9), “moderate” support (3 to 5) and “high” support (5.1 to 7) [ 25 ].

2.2.3 School satisfaction.

School satisfaction was measured by the question: “How do you feel about school at present?”, response options were: “I like it a lot”, “I like it a bit”, “I do not like it very much” or “I do not like it at all” [ 21 ].

2.2.4 Life satisfaction.

Adolescents’ life satisfaction was assessed through the adapted version of the Cantril ladder graduated from 0 to 10, with the value 10 equivalent to "the best life possible" and the value 0 to "the worst life possible" [ 26 ]. A binary variable was created: “low” life satisfaction (from 0 to 5) versus “average to high” life satisfaction (from 6 to 10) [ 21 ].

2.2.5 Socio-demographic variables.

Socio-demographic factors we included were: gender, age (10–12 years/13-14 years) and family structure (two-parent families/blended families/one-parent families).

Adolescents were asked to indicate their country of birth and that of their parents. A “migration status” indicator was created and divided into three categories: the “first generation immigrants” (adolescents born abroad and whose parents were both not born in Belgium); the “second generation immigrants” (those born in Belgium who had at least one parent born abroad); and the “natives” (those who had both parents born in Belgium).

In addition, the adolescents’ socio-economic status was assessed through the revised Family Affluence Scale (FAS), which is composed of six items and has been previously validated [ 27 ]. Individual FAS scores ranged from 0 to 13; they were subject to a ridit transformation and classified into three groups, i.e. “low”, “medium”, and “high”, corresponding to the 20% of adolescents with the lowest FAS scores, 60% of adolescents with intermediate scores, and 20% of adolescents with the highest FAS scores, respectively.

2.3. Statistical analyses

To improve the estimates’ representativeness, individual weighting factors were calculated according to the inclusion probability of schools in the initial sample, schools characteristics (size, province, network and socioeconomic status) and the differences observed between the adolescents who took part in the survey and those of the reference population in terms of school grade and gender. These weighting factors as well as the sample design were taken into account in all the statistical analyses.

After the description of the sample, univariate analyses were performed to identify characteristics and behaviours associated with adolescents’ alcohol consumption during the last 30 days before the survey. Statistical associations were estimated using Pearson’s chi-square tests (Rao & Scott correction for the sampling plan). Odds ratio (OR) and 95% confidence intervals [95%CI] were calculated using logistic regressions [ 28 ]. All indicators associated with alcohol consumption in the univariate analyses with a P-value<20% were included in the multivariable models. Inter-correlations between explanatory variables were tested using Cramer’s V test; all values were lower than 0.25 ( S1 Appendix ). All statistical analyses were performed using Stata ® V.14.

Table 1 presents the characteristics of the sample, overall and by gender. Alcohol use during the month before the interview was higher in boys than in girls. The proportion of adolescents feeling supported by their family was higher in boys (83%) than in girls (76%). The opposite situation was observed for peer support (boys: 66%; girls: 76%). About a third liked school a lot (boys: 27%; girls: 35%). Almost all had a high level of life satisfaction (boys: 92%; girls: 87%) ( Table 1 ) .

HBSC, French-speaking Walloon schools in Belgium, 2018.

https://doi.org/10.1371/journal.pone.0245597.t001

In univariate analyses, in boys, all characteristics and behaviours except family structure and peer support, were significantly associated with alcohol consumption ( Table 2 ) . In girls, only age, family support, school satisfaction and life satisfaction were significantly associated with alcohol consumption. In the multivariable logistic regression models ( Table 2 ) , age, family support and school satisfaction were significantly associated with alcohol consumption in both boys and girls. Adolescents aged 13–14 years (vs. 10–12 years: boys: ORa = 3.14 [2.34–4.22]; girls: ORa = 4.45 [3.15–6.28]) were more likely to have consumed alcohol in the last 30 days preceding the survey. Associations between family support and early alcohol consumption were a little different between boys and girls. Girls who felt “moderate” (ORa = 1.59 [1.04–2.43]) or “low” (ORa = 1.94 [1.17–3.21]) support by their family were more likely to have consumed alcohol during the past month compared with the “high” category. In boys, this association was only statistically significant in the “moderate” versus the “high” categories (ORa = 1.58 [1.13–2.22]). In both boys and girls, school satisfaction was inversely associated with alcohol consumption. Compared with those who liked school very much, those who liked school a bit (boys: ORa = 2.15 [1.45–3.20]; girls: ORa = 1.68 [1.08–2.60]), those who did not like school very much (boys: ORaa = 2.33 [1.25–4.33]; girls: ORa = 2.12 [1.30–3.46]), and those who did not like school at all (boys: ORa = 4.88 [2.85–8.36]; girls: ORa = 3.35 [1.85–6.08]), were more likely to have consumed alcohol in the last 30 days before the survey ( Table 2 ) .

https://doi.org/10.1371/journal.pone.0245597.t002

In boys only, migration status and FAS were significantly associated with early alcohol consumption ( Table 2 ) . Boys from “low” FAS (ORa = 0.56 [0.32–0.98]) or “medium” FAS families (ORa = 0.63 [0.43–0.92]) compared with those from “high” FAS families were less likely to have consumed alcohol during the past month. Lastly, second-generation immigrant boys (ORa = 0.66 [0.47–0.92]) were less likely to have consumed alcohol compared to natives ( Table 2 ) .

4. Discussion

The aim of this study was to identify potential gender differences in the correlates of alcohol consumption in early adolescence. We did not find any gender difference with the psychosocial indicators. The main gender differences were found for migration status and FAS, which were significantly associated with alcohol consumption in boys only. Indeed, our results showed that second-generation immigrant boys were less likely to have consumed alcohol compared to natives. Consistently with these findings in boys, a Dutch longitudinal study in adolescents age 10–14, found that being a native was a predictor of early alcohol use [ 9 ]. Some cross-sectional studies came to the same conclusion [ 29 ]. However, the results could differ depending on the country of origin of the immigrant adolescent. In fact, alcohol consumption in adolescents is closely linked to religion as well as to the culture and customs of the country of origin. For instance, prevalence of alcohol consumption is generally higher in adolescents from Eastern European countries compared with those from Northern Europe [ 30 , 31 ].

Concerning FAS, boys from “low” FAS or “medium” FAS families compared with those from “high” FAS families were less likely to have consumed alcohol during the past month. In a recent review, no clear pattern of associations between socio-economic status (SES) and alcohol consumption was identified [ 32 ]. A meta-analysis focusing on adolescents aged 10–15, indicated that the lower the SES, the higher the prevalence of alcohol use. However, results were inconclusive when regarding European studies only [ 33 ]. Some authors have suggested that these conflicting results between studies may be partly due to the measures used to assess the SES (e.g. parents’ education level, occupational status, family affluence or income) and the drinking behavior assessed (sipping, lifetime use, binge drinking, etc.) [ 22 , 34 – 36 ]. For example, several studies have shown that alcohol misuse was more prevalent among adolescents with low SES, whereas experimental alcohol use occurred more often among those with high SES [ 34 , 35 ]. No study focusing on gender differences in the association between SES and early alcohol consumption was found.

The influence of the family structure on adolescents’ substance use has been widely studied [ 37 , 38 ]. It has been argued that living in two-parent families could play a protective role on adolescent substance use. This hypothesis was confirmed by many cross-sectional and longitudinal studies [ 29 , 39 ]. Very few studies have focused on potential gender differences however. One study, in 11-15-year-old Flemish adolescents, showed that boys from blended families and girls from one-parent families were more likely to consume alcohol at least once a week in comparison with adolescents from two-parent families [ 40 ]. In our study, even in the univariate analysis, no association was found at all. Further research therefore is needed to confirm whether any relationship between early alcohol use and family structure exists.

The influence of parenting factors (parents drinking behaviour, parenting style, parent’s rules toward alcohol, etc.) on adolescent alcohol use has also been widely investigated in previous research [ 40 – 42 ]. Furthermore, a recent systematic review and meta-analysis of longitudinal studies focusing on modifiable parenting factors in adolescents aged 12–18 concluded that parental support was a protective factor related to both alcohol initiation and levels of later use [ 13 ]. Other studies among younger adolescents came to the same conclusion [ 42 ]. We also found an association between parental support and alcohol consumption in our study, with little difference between boys and girls.

In our study, in both genders, we did not find an association between peer support and early alcohol use. In the literature, several studies have examined the role on early drinking of certain determinants related to peer influence and some, such as peer approval, have been identified as predictors for starting to drink [ 11 ]. However, among the few studies that have examined this association, findings are divergent. For example, the Welsh study [ 43 ] found that peer support was a protective factor against binge drinking among 11-15-year-old adolescents, whereas another study among 15 year olds in the U.S. [ 12 ], showed that peer support neither contributed to nor protected against the alcohol use (based on alcohol consumption frequency during the last 30 days). These divergent findings might be due to a lack of comparability in the tools used to assess peer support or due to interactions with other indicators not included in this study such as peer involvement in the alcohol consumption. Further research, using a qualitative assessment, is highly needed to elucidate the role of peer support on early alcohol use.

We found a negative association in both genders between school satisfaction and alcohol consumption during the past month prior the survey. Two cross-sectional studies showed that 11-15-year olds who liked school were less likely to drink alcohol [ 43 , 44 ]. In contrast, two other cross-sectional studies found no association [ 29 , 41 ]. However, the adolescents included in these two latter were older (15 to 20 years of age) than those included in ours. It therefore may be assumed that school satisfaction may have an influence on alcohol consumption only among young adolescents.

Several studies have found a negative association between life satisfaction and early alcohol use [ 10 , 43 ]. For example, an American study showed that 10-17-year olds with “low” life satisfaction were also more likely to consume alcohol in conjunction with tobacco and/or marijuana [ 10 ]. In our study, in both gender, we found a significant association between life satisfaction and early alcohol use in univariate analysis, but this association disappeared in multivariate models, when school satisfaction was added into the models.

One strength of our study lies in the focus on adolescents from the age of 10. Although a number of studies among young adolescents identified some predictors of alcohol consumption [ 3 , 6 , 11 , 17 ], they remain too few and inconsistent between each other to be able to draw clear conclusions about such determinants. Our study also extends previous research by investigating gender differences in the association between early alcohol use and sociodemographic and psychosocial factors. Furthermore we also examined the role in this association, of some indicators which were less studied before (peer support for example). Our findings therefore provide new information on the sociodemographic and psychosocial factors possibly involved in alcohol use in early adolescence in both genders. Finally, we used a large randomized sample, which is another strength to our study.

At the same time, some limitations should also be considered. Firstly, in our cross-sectional study, no causal link can be inferred from the observations made. Indeed, bilateral associations could exist between early alcohol consumption and some characteristics such as family support. We can hypothesize that adolescents with “low” family support are more likely to drink alcohol, but alcohol consumption may also make adolescents less close to their family and therefore, feeling less supported by them. Secondly, all data collected were self-reported which can be a source of declaration bias [ 45 ]. One of them is the social desirability bias which may lead, among others, to an underestimation of alcohol consumption [ 45 , 46 ]. Another possible bias is linked to memorization due to the fact that we have asked adolescents to report their alcohol consumption during the past month. Nevertheless, some evidence is available that short recall periods like we used here lead to more accurate reporting [ 45 ].

5. Conclusion

We investigated the determinants of alcohol consumption among adolescents under 15 years of age taking gender into account. This topic has been insufficiently treated so far, with the exception of family support and peer influence. Our findings therefore provide crucial new knowledge about this public health issue, since alcohol consumption in young adolescents can have serious consequences for their current and future health and quality of life.

Whereas both genders shared common risk factors (age, family support and school satisfaction), our findings have highlighted gender differences in the following sociodemographic risk factors associated with early alcohol consumption: migration status and FAS. Nevertheless, since a number of the potential determinants we have analysed here have received little attention in the previous studies, we need research on gender-specific determinants of early alcohol consumption to draw firm conclusions. This knowledge will help the developers of public health policies and actions to better target and adapt messages to the most vulnerable adolescents.

Supporting information

S1 appendix. inter-correlations between variables included in the study..

https://doi.org/10.1371/journal.pone.0245597.s001

Acknowledgments

The authors thank the schools and adolescents for their participation in the French-speaking Belgian HBSC survey. They also thank the HBSC International Coordination Center (University of St. Andrews, United Kingdom) and the HBSC Data Management Center (University of Bergen, Norway) for their scientific support. They are grateful to Estelle Méroc, Nathalie Moreau, Amélie Bellanger, Morgane Eggen and Omer Cimpaye for their contribution in the data collection and analysis, and to Louise Mennen for scientific editing.

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14. Inchley J, Currie D, Young T, Samdal O, Torsheim T, Augustson L, et al. Health behaviour in school-aged children (HBSC) study: International report from the 2013/2014 survey. http://www.euro.who.int/__data/assets/pdf_file/0003/303438/HSBC-No.7-Growing-up-unequal-Full-Report.pdf?ua=1 .
19. HBSC International Coordinating Centre Child & Adolescent Health Research Unit. About HBSC study. Available from: http://www.hbsc.org/about/index.html .
20. HBSC International Coordinating Centre Child & Adolescent Health Research Unit. Survey Methods. Available from: http://www.hbsc.org/methods/index.html .
21. Currie C, Inchley J, Molcho M, Lenzi M, Veselka Z, Wild F. Health Behaviour in School-aged Children (HBSC). Study protocol: Background, methodology and mandatory items for the 2013/14 Survey. St Andrews: CAHRU. 2014.
25. Zimet GD. Multidimensional scale of perceived social support (MSPSS)—Scale items and scoring information. Available from: http://gzimet.wix.com/mspss .
30. Inchley J, Currie D, Vieno A, Torsheim T, Ferreira-Borges C, Waber MM, et al. Adolescent alcohol-related behaviours: trends and inequalities in the WHO European Region, 2002–2014. Available from: http://www.euro.who.int/__data/assets/pdf_file/0007/382840/WH15-alcohol-report-eng.pdf?ua=1 . 2018.
31. Kraus L, Guttormsson U, Leifman H, Arpa S, Molinaro S, Monshouwer K et al. ESPAD Report 2015. Results from the European School Survey Project on alcohol and other drugs. ESPAD and EMCDDA. Luxembourg. Publications Office of the European Union. 2016. Available from: http://www.espad.org/sites/espad.org/files/ESPAD_report_2015.pdf .

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National Research Council (US) and Institute of Medicine (US) Committee on Developing a Strategy to Reduce and Prevent Underage Drinking; Bonnie RJ, O'Connell ME, editors. Reducing Underage Drinking: A Collective Responsibility. Washington (DC): National Academies Press (US); 2004.

Reducing Underage Drinking: A Collective Responsibility.

Hardcopy Version at National Academies Press

4 Understanding Youth Drinking

A dolescents in the United States grow up in a world filled with messages about alcohol (see Box 4-1 for select vignettes). Most of the messages present drinking in a positive light, and most of them show alcohol as a normal part of adult and teen social life. Warnings against underage drinking from parents or in health class may well be drowned out by the barrage of daily messages about alcohol in daily life.

Select Vignettes of Alcohol Messages to Youth. Twelve-year-old Jenna rides her bike to and from school most days. Her route takes her past a large billboard advertising a popular malt liquor. Fourteen-year-old Joshua loves to watch basketball on television. During (more...)

Given this backdrop, it is not surprising that experimental or occasional use of alcohol is reported by the majority of adolescents in the United States, making it a normative behavior during the second decade of life. As noted in Chapter 2 , about 50 percent of 20-year-olds report having recently drunk alcohol and the majority of twelfth graders (78 percent) report having drunk alcohol in their lifetimes. In this chapter we examine factors—primarily developmental and environmental factors—that are related to normative alcohol consumption. We do not discuss those involved in excessive or atypical use (e.g., youths with mental or addictive disorders). This is an important distinction because the factors that contribute to drinking patterns within the normative group of adolescents are different than those for youth who develop alcohol abuse patterns or dependency at a young age.

WHY DO ADOLESCENTS SAY THEY DRINK?

Adolescents say they drink for many of the same reasons as adults ( Dunn and Goldman, 1996 ). Alcohol-related expectancies are well formed by age 12, among drinkers as well as among those who have never consumed alcohol ( Christiansen et al., 1982 ; Jones et al., 2001 ). Although it is always difficult to know if individuals can accurately report the reasons for their behavior, including drinking (see Nisbett and Wilson, 1977 ), both adolescents and adults indicate that alcohol is an important ingredient in social interactions, allowing them to lower their inhibitions and feel more relaxed in social situations ( Jones et al., 2001 ; Wood et al., 1992 ). Other reasons given for drinking include reducing tension, fostering courage, reducing worry, increasing a sense of power, and causing cognitive and behavioral impairment ( Prendergast, 1994 ). In addition, most individuals assign some costs to drinking, as well, which are discussed later in this chapter.

According to models such as the theory of planned behavior ( Ajzen, 1991 ), social cognitive theory (e.g., Bandura, 1986 ), and alcohol expectancy theory (e.g., Goldman et al., 1991 ; Leigh, 1989 ), alcohol use can be largely explained by the alcohol-related expectancies for both positive and negative outcomes. Initiation and continuation of drinking, as well as the onset of problem drinking, are strongly and positively associated with expected benefits of drinking and negatively related to perceived negative expectancies ( Christiansen et al., 1989 ; Christiansen et al., 1982 ; Chen et al., 1994 ; Grube et al., 1995 ; Jones et al., 2001 ; Smith et al., 1995 ; Wood et al., 1992 ; Goldberg et al., 2002 ).

Although children's and adult's alcohol expectancies are similar ( Dunn and Goldman, 1996 ), younger children are more likely to report negative expectancies; perceptions of positive outcomes increase with age ( Miller et al., 1990 ; Goldberg et al., 2002 ). Specific expectancies also differ by age: 12- to 14-year-olds rank reduced tension and impaired behavioral functioning highest; 15- to 16-year-olds cite enhanced social and physical pleasure and modified social and emotional behavior; and 17- to 19-year-olds cite enhanced sexual performance and increased power as top alcohol expectancies ( Christiansen et al., 1982 ). There are also gender differences in alcohol expectations, with adolescent males perceiving more positive and fewer negative consequences of alcohol than do adolescent females. Although the relationship between quantity of alcohol use and social and physical outcomes was similar for adolescent males and females, the frequency of alcohol use may be associated with global positive effects, sexual enhancement, and pleasure for men, but reduced tension for women ( Jones et al., 2001 ).

DEVELOPMENTAL FACTORS

During adolescence, individuals are going through rapid physical, social, and cognitive changes. These enormous changes to body, friendship, and thinking about the world are juxtaposed against changing expectations for behavior and increases in need and opportunities for autonomy. The desire to be autonomous and to be granted more decision making opportunities increases with age ( Steinberg and Cauffman, 1996 ) and occurs in tandem with several other changes that serve to increase adolescents' desires for autonomy. First, the physical changes of puberty result in adolescents' seeing themselves as more deserving of adult-like privileges and opportunities to make decisions. In addition, as adolescents mature physically and develop secondary sex characteristics, they look older and are presumed to be able to take on more adult-like roles and responsibilities. Second, increased time spent with peers leads to more experiences and comparison of others' authority, power, and privileges. Third, cultural and societal beliefs suggest that adolescence is a time to practice adult roles. All of these factors serve to underscore the importance of autonomy from parents and push adolescents toward assuming more adult roles. In the United States, alcohol use is an important symbol of adult status.

The shift away from childhood and toward independence and adult roles is accompanied by a focus on peer acceptance and perceived norms in addition to parental standards. Adolescents need to develop their own sense of self or identity during this time, although expectations about the appropriate timing for increased autonomy during adolescence varies across cultures (e.g., Feldman and Rosenthal, 1990 ). Individuals adapt and modify their identities to enable them to function best in their particular social and cultural context ( Baumeister and Muraven, 1996 ). Adolescents may “try on” various identities that will be defined, in part, by how time is spent and with whom it is spent. While constructing an identity, an adolescent's motivation may be to gain new experiences that will allow them to evaluate what fits and what does not with their newly developing identities. This process allows them to create adult selves that are realistic and comfortable ( Curry et al., 1994 ). During this period, adolescents report having a “true self” (who they really are inside) and a “false self” (who they want other people to think they are, to impress or please them) ( Harter et al., 1996 ). At this point, adolescents may knowingly make choices that they know they may later regret “just to see what it is like,” to act more like an adult, or to impress others (e.g., Moffit, 1993 ). Some of these choices are likely to involve alcohol consumption.

In order to understand the shifts that adolescents are undergoing, it is important to consider both changes in cognition and in the social world in which adolescents find themselves during this period.

Cognitive Changes

Cognitive changes during adolescence include gradual improvements in social perspective, to about age 16 ( Steinberg and Cauffman, 1996 ). These newfound perspective-taking skills allow an adolescent to recognize how the thoughts and actions of one person influence those of another and to imagine how others might perceive them. Although generally an indicator of greater maturity, a downside of this new ability is that adolescents are highly concerned with peer conformity, which may make them particularly susceptible to peer influence. The majority of studies indicate a positive relationship between susceptibility to peer pressure and risk-taking behavior (such as drinking). For reasons not yet known, there is variation in the extent to which adolescents succumb to social influence, including pressure to engage in behaviors that are undesirable (see Steinberg and Cauffman, 1996 , for a review).

In general, thinking becomes more abstract and more future-oriented during adolescence, allowing adolescents to consider multiple aspects of any decision at one time, assess potential consequences of a decision, consider possible outcomes associated with various choices, and plan for the future. These cognitive changes enhance the adolescent's capacity for competent decision making (see, for example, Halpern-Felsher and Cauffman, 2001 ; Steinberg and Cauffman, 1996 ). However, these newly formed competencies are not always practiced when adolescents are confronted with real-world social situations. Many studies suggest that adolescents, as well as adults, may make less than optimal decisions when personal goals, beliefs, prior experience, values, social expectations, and emotions are added to the decision making equation ( Jacobs and Klaczynski, 2002 ). This outcome is especially true for social decisions (like choosing whether to drink or how much to drink). This is so for a variety of reasons.

First, outcomes of decisions in social situations are probabilistic, meaning that negative consequences of bad decisions may not occur and may not even be highly likely, although they are devastating if they do occur. For example, while the probability of having a car crash after drinking is much higher than after not drinking, drinking and driving does not always end in a crash or a ticket. Because outcomes are probabilistic, adolescents may interpret the fact that they previously drank too much and drove home without a crash as evidence that they can drink and drive safely ( Jacobs and Ganzel, 1994 ). In one study, older adolescents who had a lot of experience drinking and driving, but had not experienced a negative outcome, such as a traffic citation or crash, believed that they were in little danger of having an accident after drinking ( Finken et al., 1998 ), this result suggests that engaging in risky behaviors without consequence may have caused them to lower their perceptions of the risks of drinking and driving. Other correlational studies have shown that greater involvement in risk-taking behaviors was related to lower perceptions of personal risk (e.g., Halpern-Felsher and Cauffman, 2001 ; Goldberg et al., 2002 ). Second, the norms for social decisions are not typically known. Instead, individuals are often forced to make judgments on the basis of their own estimates of the norms of social behaviors or attitudes. This general dilemma, faced by people of all ages, is even more difficult for adolescents because they must make decisions based on a limited amount of experience and little feedback from earlier decisions ( Jacobs et al., 1995 ). Several studies indicate that most adolescents overestimate the number of others who drink alcohol (e.g., Basch et al., 1989 ; Jaccard and Turrisi, 1987 ). Not surprisingly, the overestimation is greatest for those individuals who drink. This same pattern has been found for other risk-taking and deviant behaviors (e.g., Benthin et al., 1993 ; Nucci et al., 1991 ), and it may be related to the fact that those who drink have friends who drink and so they begin to believe that everyone is drinking. In one longitudinal study, adolescents who spent time with peers who encouraged drinking later reported more positive views of drinkers ( Blanton et al., 1997 ).

In addition, studies indicate that adolescents make more biased estimates when they are reasoning about populations with greater variability and when they are reasoning about unfamiliar others ( Jacobs, 2004 ) Underage drinking and other forms of risk taking are likely to occur in social situations and when adolescents find themselves with large groups of unfamiliar peers. In these situations, they are left to estimate how others typically behave and what they think. The outcome may be overestimates of others' drinking and acceptance of such behavior, leading them to believe that the norm is to drink and that they should do it, too. However, providing adolescents with more realistic information about the extent to which people drink alcohol may not by itself reduce alcohol consumption. Instead, a focus on injunctive norms—views concerning what others think about one's drinking—might be more effective ( Cialdini et al., 1990 ; Kallgren et al., 2000 ; Prentice and Miller, 1993 ).

Social Situations

The social situations in which adolescents find themselves also change during this period. Indeed, movement toward autonomy is accompanied by real and perceived changes in the social world as adolescents mature. Most move from environments in which they are protected, scheduled, and dominated by adults into environments that are primarily populated with other adolescents and in which they actually have much more autonomy. On average, middle-class adolescents spend about 20 percent of their time with parents and other relatives, 25 percent of their time alone, and the rest with friends and classmates ( Csikszentmihalyi and Larson, 1984 ). Younger adolescents report that television and home- and family-centered activities fill much of their leisure time, but this shifts dramatically as they get older and report that peer-focused and solitary activities fill most of their time ( Larson and Kleiber, 1990 ). Thus, as adolescents get older, they spend greater periods of their leisure time away from adult supervision, increasing the opportunities for becoming involved in such risk-taking behaviors as drinking alcohol.

In addition to the actual changes in supervision, teens are much more focused on real or imagined peer norms. They are most likely to attend to the standards set by their friends than by another same-age group. The often reported, “peer pressure” is, in reality, “friend pressure.” As adolescents get older, they are more likely to choose friends who share their tastes and interests than when they were younger. Thus, they are likely to join crowds of teens who have similar values and life-styles. Crowd membership has been associated with alcohol consumption: some crowds or groups include drinking as part of how they spend their time, and an adolescent's choice to be involved in that crowd will include the knowledge that drinking is a typical activity for that group ( Prinstein et al., 1996 ). For example, participation in competitive sports in high school has been related to higher rates of alcohol use ( Eccles and Barber, 1999 ).

Unfortunately, information about a particular group's norms may not be available until after an adolescent has had one or more experiences with the group and has been faced with situations in which saying “no” to alcohol will be viewed unfavorably by peers. Younger adolescents report having more trouble moving between crowds than older adolescents, so it may be more difficult for them to go against the norms of a crowd if they feel uncomfortable ( Brown et al., 1994 ).

INDIVIDUAL DIFFERENCES

Although we have concentrated on describing the normative changes that affect adolescents, there are clear individual differences in development as well, and some of these differences may be associated with higher alcohol consumption. These differences include personality, perceptions of risk, and self-efficacy, as well as gender and racial differences in adolescent alcohol consumption (noted in Chapter 2 ). Although numerous clinical studies indicate that individuals differ in their likelihood of experiencing alcohol dependency and related disorders ( Kessler et al., 1997 ; Swendsen et al., 2002 ), our focus in this chapter remains on nonclinical populations.

Personality Differences

Is there a personality profile that is related to adolescent risk for alcohol abuse? Cloninger (1991) found that three traits, present as early as age 10, were associated with alcoholism at age 28: (1) being easily bored and needing constant stimulation; (2) being driven to avoid negative consequence for actions; and (3) craving immediate external rewards for efforts. In addition, antisocial personality disorder has been linked to alcohol misuse among adolescents ( Clark et al., 1998 ). Similarly, a recent study of children aged 8 to 15 found that conduct disorder often predates and predicts later alcohol use ( Clark et al., 1998 ).

In nonclinical populations, a major personality characteristic that has been related to adolescent risk taking is sensation seeking, defined by seeking novel, complex, or risky situations ( Zuckerman, 1979 ). The appeal of drinking alcohol and other “forbidden” behaviors for adolescents may be the novel and intense sensations provided by the experiences ( Arnett and Balle-Jensen, 1993 ); students who have higher needs for sensation seeking are more likely to report higher levels of drinking, as well as other delinquent behaviors. Others have also reported associations between sensation seeking or novelty seeking and alcohol use (e.g., Martin et al., 2002 ). Donohew and colleagues (1999) argued that sensation seeking influences alcohol use indirectly, through peer affiliations: teens who are sensation seekers tend to choose friends with similar sensation seeking desires, and such peer group affiliations increase alcohol use.

Beliefs About Risk

Although many adults believe that adolescents underestimate the risks of engaging in particular behaviors, most research indicates that adults and adolescents actually give similar estimates of various types of risk taking, including drinking alcohol (e.g., Beyth-Marom et al., 1993 ; Quadrel et al., 1993 ). Although sweeping age differences in risk estimates have not typically been found ( Millstein and Halpern-Felsher, 2002 ), individuals' perceptions of risk vary, and their perceptions have been linked to their behaviors. In general, drinkers of all ages view consuming alcohol as less risky than nondrinkers ( Goldberg et al., 2002 ), although the absolute accuracy of various risk perceptions has been the topic of debate (e.g., Slovic, 2000 ). Although adolescents generally overestimate their mortality risks for a variety of activities including alcohol (e.g., Fischhoff et al., 2000 ), recent studies suggest that adolescents who perceive a higher likelihood of negative consequences following alcohol consumption do not drink at all or drink more moderately than others (e.g., Goldberg et al., 2002 ; Halpern-Felsher and Cauffman, 2001 ; Small et al., 1993 .)

Both adults and adolescents tend to overestimate how many other people are involved in activities in which they, themselves, are engaged (e.g., Kruglanski, 1989 ). Indeed, adolescents as well as adults who participate in high-risk activities generally believe that the rate of participation by others is higher than do nonparticipants ( Benthin et al., 1993 ); thus, beliefs about normative practices may be related to older adolescents' decisions to engage in risky behaviors ( Basch et al., 1989 ; Beck and Treiman, 1996 ; Olds and Thombs, 2001 ). In one recent study, adolescents who reported higher levels of alcohol consumption and other risk-taking behavior than their peers overestimated how much other adolescents in their school were participating in the same high-risk behaviors ( Jacobs, 2000 ). Extreme overestimaters engaged in significantly more mild and severe deviant behaviors than either the moderate overestimaters or those whose estimates were correct, and they reported poorer self-esteem, lower grade point averages, and less rational decision-making skills. One of the most intriguing implications of the research focusing on individual differences is that some adolescents are more likely than others to perceive drinking as low risk, to overestimate the likelihood of others' drinking, and to look for sensation-seeking opportunities. This is the group that one would expect to drink the most and take the most risks when drinking.

Prior Experience

Although correlated with age, drinking experiences have a significant and independent effect on alcohol expectancies, which in turn play a role in alcohol use ( Christiansen et al., 1989 ; Christiansen et al., 1982 ; Chen et al., 1994 ; Grube et al., 1995 ; Jones et al., 2001 ; Smith et al., 1995 ; Wood et al., 1992 ; Goldberg et al., 2002 ). More specific expectancies, such as enhanced sexual feelings, power, and reduced tension have been reported by those with greater drinking experiences, while youth with little or no alcohol experiences have more global expectancies of increased pleasure ( Christiansen et al., 1982 ). As one gains more experience with alcohol, positive outcomes are reinforced and predict future drinking behaviors ( Goldberg et al., 2002 ; Jones et al., 2001 ). Furthermore, positive drinking-related expectancies increase and negative expectations for risks decrease among adolescents with more drinking experiences ( Halpern-Felsher et al., 2000 ; Goldberg et al., 2002 ).

Self-Efficacy

Drinking refusal self-efficacy, borrowed from Bandura's (1986 , 1997 ) concept of general self-efficacy, refers to one's belief in her or his ability to resist urges or social pressures to drink, to drink in particular situations, or to consume large amounts of alcohol at one time. Adolescents with more positive self-efficacy are less likely to drink or drink excessively ( Oei et al., 1998 ; Webb and Baer, 1995 ), and those with fewer refusal skills are more likely to drink ( Hays and Ellickson, 1996 ). Refusal skills may be a better predictor of problem drinking than alcohol expectancies, especially for heavy or frequent alcohol use ( Connor et al., 2000 ; Oei et al., 1998 ). Given that adolescents are more susceptible to peer pressure, it stands to reason that they will have lower drinking refusal skills. However, there is evidence that adolescents can be taught drinking refusal self-efficacy skills and that such skills can then result in less substance use ( Bell et al., 1993 ; Ellickson et al., 1993 ).

CONTEXTUAL FACTORS

As noted in the previous chapter, the highest rate of both heavy drinking and frequent heavy drinking is found in young adults between the ages of 18 and 25. In addition, if adolescents between the ages of 14 and 20 drink alcohol, they are more likely to report heavy drinking than other drinking patterns ( National Household Survey on Drug Abuse, 2001 ). These findings suggest that there may be something about the context of youth drinking that results in this particular pattern of alcohol consumption. Indeed, macrolevel and microlevel contextual factors are likely to contribute to both the number of underage drinkers and their patterns of alcohol use.

U.S. culture is replete with messages touting the attractions of alcohol use, and—notwithstanding the legal norm—suggesting that drinking is acceptable for people under 21. Recent content analyses indicate that alcohol use was depicted, typically in a positive light, in more than 70 percent of a sample of episodes in prime-time television programming in 1999 ( Christensen et al., 2000 ), and in more than 90 percent of the two hundred most popular movie rentals for 1996-1997 ( Roberts et al., 1999b ). Roberts et al. (1999b) also found that 17 percent of the 1,000 of the most popular songs in 1996-1997 across five genres of music popular with youth contained alcohol references, including almost one-half of the rap music recordings. The alcohol industry spent $1.6 billion on advertising in 2001, and probably twice that much in other promotional activity. Young people are exposed to a steady stream of images and lyrics presenting alcohol use in an attractive light.

Within any country, the specific community environment may contribute to drinking to a greater or lesser extent. The drinking environment can be characterized as varying on a “wet-dry” continuum. A “wet” community environment is one in which drinking is prevalent and common, public opinion is generally tolerant or positive, and alcohol is readily available both commercially and at private social occasions and is advertised as available. A “dry” community would be one in which drinking at social occasions is not the norm and is generally frowned on, and alcohol outlets are relatively scarce. One commonly used statistical indicator for the “wetness” of the environment is the per capita consumption of alcohol (the average number of drinks per person) for the population age 14 and over per year. In the United States, for example, per capita consumption ranged from 1.3 gallons of ethanol per capita in Utah to 2.8 gallons in Wisconsin, in 1997; see Table 4-1 .

Alcohol Consumption, 1999.

To what extent do environmental factors influence individual drinking choices by youth? It is interesting in this regard to analyze trends in youth drinking over time. Based on their analysis of Monitoring the Future data for high school seniors, Cook and Moore (2001) report that the 30-day prevalence of drinking and also of heavy drinking 1 peaked in 1979, and then declined by approximately one-third (30.6 and 37.5 percent, respectively), reaching a low point in 1993 and increasing only slightly since then. This downward trend is unrelated to demographic changes in the composition of the population of high-school seniors and cannot be fully explained by trends in prices, minimum drinking age, or availability ( Cook and Moore, 2001 ). However, this trend in drinking prevalence closely tracks the societal trend in drinking, as measured by national per capita consumption. Thus, whatever the reason for the decline in youth drinking during the 1980s, it seems to be related to, and perhaps in some sense is the result of, the overall decline in drinking in the society.

More persuasive evidence of the link between “wetness” and youth consumption comes from a study of individual drinking behavior. Cook and Moore (2001) analyzed data from the National Longitudinal Survey of Youth (NLSY) that included annual items on individual drinking for 1982-1985 and 1988-1989. The initial cohort of 12,000 respondents ranged in age from 17 to 24 at the beginning of this period in 1982, so that the NLSY data provide information on drinking trajectories for older teens and those in their twenties. They found that, even after controlling for family, religion, schooling, aspirations, employment, and cognitive ability, various aspects of the environment contributed significantly to patterns of drinking. Specifically, youth with similar backgrounds and individual characteristics were more likely to drink if they lived in a state with relatively high per capita consumption.

The minimum drinking age and the excise tax on beer are also related to youth drinking. Thus, an 18-year-old living in a state in which his drinking was legal in 1982 would have been more likely to drink (and to drink heavily) than an identical twin living in a state with a higher minimum drinking age. Increases in the beer tax (which has a direct effect on average price) generally tend to lower drinking, although it is harder to pin down with the NLSY data; however, other studies are quite consistent at documenting that taxes and prices influence youth drinking ( Chaloupka and Wechsler, 1996 ). This research suggests that a “wetter” environment may provide adolescents with more social occasions to drink, more positive attitudes about drinking, more advertising and outlets, and more lenient regulations concerning the sale and consumption of alcohol. In short, such environments have an enabling effect on underage drinking.

In addition to specific community norms for drinking, several other societal factors may affect the prevalence of heavy drinking in adolescence. First, U.S. society is largely segregated by age. As adolescents get older, they spend more and more time alone or with other peers in unsupervised settings, and both age-segregation and lack of adult supervision have been related to higher levels of substance abuse and deviance, including greater alcohol consumption. “Hanging out” with friends in unstructured, unsupervised contexts is generally related to negative outcomes, while spending time with others in adult-sanctioned, structured contexts is generally related to positive outcomes (e.g., Osgood, 1998 ; Osgood et al., 1996 ).

A particularly vulnerable time for youth is the after-school period, 3:00 to 6:00 p.m. This time is especially likely to be unsupervised as adolescents get older and parents believe that it is “safe” to leave them at home unattended. Youth who participate in after-school programs, such as sports, clubs, library-based activities, and youth-serving organizations are less likely to use alcohol than nonparticipants ( Eccles and Barber, 1999 ). The same point about age segregation and lack of supervision applies to adolescents' attendance at unchaperoned parties and other activities. It is not uncommon for caring parents to decide to host an all-night party with alcohol for their teenage children, taking the car keys from the guests as they arrive, on the theory that it is safer to allow drinking at home rather than to forbid it and have teens drink and drive. Individuals or organizations that host and support such events are providing opportunities that enable adolescents to drink to excess. Not surprisingly, having parents who sanction alcohol use (even in “controlled” settings) is related to heavier drinking among adolescents ( Barnes et al., 1995 ; Peterson et al., 1994 ).

By and large, adolescents are even segregated by age in the workplace. Adolescents who work for pay are often employed in fast-food and similar jobs in which most of their coworkers are other adolescents ( Mortimer et al., 1992 ). It is not uncommon for a 17-year-old to be managing a fast-food establishment and supervising 15- and 16-year-olds. Given this situation, it may not be surprising that part-time work during adolescence is positively related to involvement in drugs, alcohol, and other deviant behaviors (e.g., Bachman and Schulenberg, 1993 ; Greenberger and Steinberg, 1986 ; Steinberg et al., 1993 ).

The place in which adolescents are most segregated is likely to be at residential colleges. Although less than one-quarter of college students are in such settings, student-segregated apartments or college residence halls provide the conditions under which binge drinking is likely to occur: cultural norms that support drinking, little supervision by any adults, and peers who are likely to be heavily involved in drinking. In a recent study, Cook and Moore (2001) found support that college students are more likely to engage in drinking, especially heavy drinking, if they live in a dormitory than if they live off campus, even after controlling for other factors (such as age) that might explain this difference.

Social Setting

While adolescents are experiencing community-level influences related to the place of alcohol in our society, each adolescent is also making decisions about drinking within a particular social setting. Of particular importance with regard to social influences are adolescents' peers and friendship networks and their changing relationships with their parents. The effect of parents' and peers' alcohol consumption on adolescents' drinking patterns is both direct, through observation and modeling ( Bandura, 1986 ) and indirect, through its influence on alcohol-related expectancies and attitudes (see Kuther, 2002 , for a review).

Adolescents in the United States spend approximately twice as much time with peers as they spend with parents or other adults. Accordingly, peers are a major source of socialization and development for adolescents. Research supports the notion that both selection and socialization factors contribute to observed similarities in behavior among friends. That is, adolescents are influenced by the normative behaviors of their peers and they choose peers who reinforce their own norms and values ( Kandel, 1978 ). The influences of peers are both direct and indirect ( Bauman et al., 1989 ; Biddle et al., 1980 ; Ennett and Bauman 1991 ; Pruitt et al., 1991 ; Kandel and Logen, 1984 ). That is, adolescents are influenced directly (e.g., by observing peers' behavior or by peer pressure) and indirectly (e.g., by their perceptions of the extent to which their friends are drinking alcohol). The combination of the normative aspect of alcohol use and peer influences on underage alcohol use is also important. Youth are well aware of the normative nature of alcohol use, and they usually want to go along with their peer group ( Aas and Klepp, 1992 ; Barnes et al., 1995 ; Beck and Treiman, 1996 ; Olds and Thombs, 2001 ). Perceived use of alcohol by one's peers and friends independently predicts self-reported alcohol use (e.g., Olds and Thombs, 2001 ; Reifman et al., 1998 ), with peers having a greater influence on adolescent drinking than do parents ( Kuther, 2002 ).

It should be noted, however, that interventions that attempt to prevent or reduce alcohol consumption by focusing on changing perceptions of social norms must proceed cautiously. Research conducted by Cialdini and colleagues ( Cialdini et al., 1990 ; Kallgren et al., 2000 ) points to the need to distinguish between descriptive norms (perceptions of what most others are doing) and injunctive norms (perception of what other people think one should be doing or not doing). Cialdini argues that focusing on injunctive norms is more effective at changing behavior than targeting only descriptive norms.

Although peers are one important influence on adolescents' choices, parents remain important during the teen years. Many adolescents report that they turn to their parents for advice regarding educational and career decisions, although they turn to their friends for advice about clothes and music ( Montemayor, 1982 ). Indeed, most theoretical perspectives today suggest that close connections to both parents and peers are related to easier transitions to independence (e.g., Allen and Hauser, 1996 ). Yet peer influences also depend in part on the quality of parent-child relationships ( Parke and Ladd, 1992 ). Adolescents who have positive relationships with their parents may be more likely to have friends who engage in socially valued activities than do adolescents with less positive parental interactions. Similarly, more involved parents may oversee and monitor their child's peer relationships more than do less involved parents, thereby reducing adolescents' engagement in undesired behaviors (see, for example, Fletcher et al., 1995 ). Parents also have a significant amount of influence on their children's choice of friends. Parents help shape prosocial and antisocial behavior, which leads children to gravitate toward particular crowds.

Parental monitoring and involvement are key components in reducing adolescent alcohol use. Monitoring of an adolescent's behavior involves the parent or guardian supervising the adolescent; knowing the adolescent's whereabouts; knowing the adolescent's friends and peers; setting expectations that are clear and optimally challenging; delivering consequences that are fair, affirming, and useful; and communicating with the adolescent ( Connell et al., 1995 ; Connell and Halpern-Felsher, 1997 ; Halpern-Felsher et al., 1997 ; Lee and Halpern-Felsher, 2001 ). Similarly, parental involvement is the extent to which parents show interest in, are knowledgeable about, and put effort into their child's activities and development. Both parental monitoring and involvement serve to prevent or reduce adolescents' health-compromising behaviors through the setting of curfews, awareness of and participation in after-school and weekend activities, prevention of adolescents' association with risky peers, and the improvement of social skills ( Beck and Lockhart, 1992 ; Cohen et al., 1994 ; Steinberg et al., 1994 ). Research on parental monitoring consistently shows protective effects on alcohol use ( Barnes et al., 2000 ; Bogenschneider et al., 1998 ; Reifman et al., 1998 ; DiClemente et al., 2001 ).

Families also provide an arena in which fledgling decision makers try their new skills and in which more experienced decision makers model appropriate behavior or even provide instruction on how to make decisions ( Jacobs and Ganzel, 1994 ). Learning to make decisions and live with their consequences and learn from them is an important developmental task that may be promoted or hindered by particular parenting practices. Although most parents give their adolescents increasing autonomy to make a wide range of decisions—in friendship, academics, extracurricular involvement, and consumer choices—many do so with little guidance or without letting adolescents experience the consequences of their actions. In addition, many parents provide an inconsistent pattern of restrictions and privileges (e.g., childlike restrictions about bedtime that don't match the adult privilege of driving the family car) that may lead adolescents to make choices that are aimed at rebelling against parental restrictions or that give them adult status (such as drinking alcohol).

Other aspects of parenting, such as parental norms and attitudes regarding adolescents' alcohol use and parents' own alcohol use, influence adolescent risk behavior. For example, Sieving and colleagues (2000) found that, in comparison with other variables, parent norms against underage drinking showed the strongest association with adolescents' abstention from alcohol use. In addition, parents, like other adults, may overestimate or underestimate drinking norms for adolescents, depending on their own experiences or their perceptions of societal norms. If parents believe that most adolescents drink, they may be more willing to “look the other way” when their children drink or to sponsor parties at which alcohol is served. Parents may benefit from knowing about other parents' practices and prohibitions concerning alcohol use by their children.

Parents' own alcohol use has also been linked to underage drinking (e.g., Pandina and Johnson, 1989 ), as well as to increased chance of experiencing alcohol-related negative consequences ( Pandina and Johnson, 1990 ). However, family history of alcohol abuse and alcoholism alone may not be adequate to predict drinking patterns among children of parents with such drinking behaviors. It is possible that other factors, such as parental monitoring, personality, and stress coping strategies, mediate between family history of alcohol use and underage drinking (e.g., Johnson and Pandina, 1993 ; Reifman et al., 1998 ).

Two studies have demonstrated that sibling alcohol use is a risk factor. Of particular interest is the study by McGue and colleagues (1996) that examined the effect of both parental and sibling alcohol use on both adoptive and biological children raised in the same families: while parental alcohol use only had an effect for the biological children, sibling use had an effect on both adoptive and biological children. The effect was stronger if the sibling was similar in age, gender, and ethnicity.

CONFLUENCE OF FACTORS

In this chapter we have listed many social, cognitive, and contextual factors that are related to the reasons that adolescents drink. In a culture that promotes alcohol use, it is impossible to isolate one factor as the primary cause. Rather, understanding why adolescents drink is more likely to be found in the confluence of factors. Positive aspects of the normal developmental process (e.g., enhanced cognitive abilities and physical maturation) are directly related to the greater autonomy and freedom from supervision enjoyed by adolescents. However, increases in autonomy lead to more opportunities to obtain and use alcohol. Likewise, normal adolescent development includes focusing on peers and searching for one's own identity and friendship niche; however, these normal developmental processes lead to trying risky behaviors and conforming to peer norms that often include alcohol use. Thus, the trends that are typically associated with healthy adolescent development also set the stage for increased opportunities for alcohol use. In addition, adolescents are coming of age in the United States are doing so in a culture that promotes and enables underage drinking.

There is little that one can change about the timetable of cognitive and emotional development or personality characteristics, but one can consider interventions for some of the factors that have been related to adolescent alcohol consumption and can be changed. The most likely targets are adolescent, parent, and community attitudes about the acceptance of underage drinking. Media and educational campaigns with this goal, however, must keep in mind many of the factors that have been reviewed in this chapter. For example, messages to adolescents must consider factors such as developmental level; the need to act adult-like, try on new identities, and make decisions with little experience; and adolescents' peer norms and biased reasoning about these norms.

Communications aimed at parents and others must provide realistic information about the prevalence of underage drinking and the dangers associated with it. In addition, adults must be given clear messages about what they may be doing to enable underage drinking and concrete examples of what they can do to convey their expectations to their children, monitor their children, and provide a community environment that discourages rather than promotes underage drinking.

Defined as five or more drinks in a row in the last 2 weeks.

Cite this Page National Research Council (US) and Institute of Medicine (US) Committee on Developing a Strategy to Reduce and Prevent Underage Drinking; Bonnie RJ, O'Connell ME, editors. Reducing Underage Drinking: A Collective Responsibility. Washington (DC): National Academies Press (US); 2004. 4, Understanding Youth Drinking.
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Alcohol use continues to be problematic for youth and young adults in the United States. Understanding of neurobiology and neuroplasticity continues to highlight the potential adverse impact of underage drinking on the developing brain. This policy statement provides the position of the American Academy of Pediatrics on the issue of alcohol and is supported by an accompanying technical report.
Enforcement of the Legal Minimum Drinking Age in the United States
As a result, extensive effort is expended to prevent youth drinking and its damaging sequelae. One policy designed to reduce youth drinking and the traffic crashes and other problems that are associated with drinking is the minimum legal drinking age of zi. Passage of age-zi laws in many. states has significantly reduced youth drinking (7 ...
Alcohol consumption in early adolescence: Associations with
Methods. Data came from the 2018 Health Behaviour in School-Aged Children (HBSC) study conducted in French-speaking schools of Belgium. The sample analysed here comprised 4,364 10-14-year olds from the Walloon Region. Associations of the recent alcohol consumption (at least one glass during the past month) with sociodemographic and psychosocial characteristics were estimated using gender ...
Thesis Statement
Thesis Statement Letter of Intent Research Paper Presentation Product Reflection Works Cited Underage drinking is becoming an epidemic. Underage drinking causes negative physical and mental effects to young people and the people around them. Powered by Create ...
Reducing Underage Drinking: A Collective Responsibility
Understanding Youth Drinking. A dolescents in the United States grow up in a world filled with messages about alcohol (see Box 4-1 for select vignettes). Most of the messages present drinking in a positive light, and most of them show alcohol as a normal part of adult and teen social life. Warnings against underage drinking from parents or in ...
PDF Underage Drinking
Underage drinking is a serious public health problem in the United States. Alcohol is the most widely used substance of abuse among America's youth, and drinking by young people poses enormous health and safety risks. The consequences of underage drinking can affect everyone— regardless of age or drinking status.
PDF Underage Drinking
Underage drinking is a serious public health problem in the United States. Alcohol is the most widely used substance among America's youth, and drinking by young people poses enormous health and safety risks. The consequences of underage drinking can affect everyone—regardless of age or drinking status. Either directly or indirectly, we all ...
PD: 2 more arrested in underage drinking party that led to ...
McALLEN, Texas (ValleyCentral) — Two women are in custody accused of providing alcohol to minors at a pool party that left a McAllen Nikki Rowe High School student dead. Michele Rodriguez Salas ...